New Student Application

Student Information

Parent/Guardian Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Health Conditions (asthma, seizures, etc.)

Emergency Contact Name/Relationship to Student

First NameLast Name

Relationship to Student

Emergency Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Student is physically active and participate in other athletic activities.

Other

Please list any other sports or activities that the student participates in.

What are you looking for in a Martial Arts Program?

Do you feel that your current schedule can accommodate martial arts training? We require a 2 day per week commitment.

If you are accepted as a student, are you prepared to follow the rules and philosophy of our Martial Arts Organization?

Waiver Form

I, the undersigned, am aware that participation in AKKA Karate USA involves inherent risks and dangers that may result in serious bodily injury, death, or property damage. I hereby agree to the following:

Assumption of Risks: I acknowledge that I am aware of the risks associated with the activity and voluntarily choose to participate.

Release of Liability: I, on behalf of myself, my heirs, assigns, and legal representatives, release and discharge AKKA Karate USA, its officers, employees, volunteers, and agents from any and all claims, liabilities, damages, or causes of action arising out of or related to my participation in the activity.

Indemnification: I agree to indemnify and hold harmless AKKA KARATE USA from any claims made by third parties arising out of my participation in the activity.

Medical Treatment: In the event of an injury or medical emergency, I consent to receive medical treatment and agree to be responsible for any medical expenses incurred.

Governing Law: This waiver and release shall be governed by and construed in accordance with the laws of the state in which the activity takes place.

I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY AND UNDERSTAND ITS TERMS. I SIGN IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Signature