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Champions Karate Student Information
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Student last name: *
Student first name: *
Student DOB: *
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Parent or Guardian: *
Cell phone *
Email address: *
Emergency contact and phone number: *
Student's address: *
Main area of interest (check all that apply): *
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Anything the martial arts instructor should be aware of including: fitness, endurance, time management, medical: *
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Please acknowledge you have read: WAIVER AND RELEASE OF LIABILITY: The School urges you and all students to obtain a physical examination from a doctor before using any exercise equipment or  participating in any exercise class. All exercises, including the use of weights and use of any and all machinery, equipment, and  apparatus designed for exercising shall be at the student’s sole risk. Student understands that the agreement to use, or selection of  exercise programs, methods and types of equipment shall be student’s entire responsibility, and the School shall not be liable to  student for any claims, demands, injuries, damages, or actions arising due to injury to student’s person or property arising out of  or in connection with the use by student of the services, facilities, and premises of the School. Student hereby holds the School,  its officers, owners, agents and employees harmless from all claims which may be brought against them by student or on  student’s behalf for any such injuries or claims.   *
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