Intro Class Registration and Waiver
JKD Unlimited Cincinnati
4845 Premier Way West Chester, OH 45069
Contact us at (513)580 - 4553 or no_reply@JKDUnlimitedCincinnati.com
Email address *
General Information:
Full Name *
Your answer
Phone Number
Your answer
What date would like to schedule for your introductory class? (If today, mark today's date) *
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DD
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YYYY
Do you have prior martial arts experience? If so, what have you practiced, how long did you practice, and what rank did you achieve?
Your answer
Do you have any prior injuries? *
Your answer
Rules and Regulations:
As a student, I must faithfully comply with all the rules and safety regulations of the Academy. I further understand that all the classes are supervised by qualified personnel and that strict observation of safety regulation will largely preclude the possibility of accident and injury. Furthermore I am physically and mentally fit to participate in a course of martial art instruction and free of any communicable/infectious disease(s) *
Required
Medical Release:
In the event of an emergency, Student or Guardian hereby authorizes transportation and licensed personnel to perform any accepted medical procedures on the Student deemed necessary or advisable, and agrees to bear the expense of such transportation or procedures. *
Required
Release of Liability:
Martial arts instruction and self defense courses offered by Jeet Kune Do Unlimited, and its owners and employees (collectively Academy), will involve sparring and physical contact with other individuals, which may result in personal injury. Other programs offered by the Academy, including stick fighting and street grappling, also present a risk of personal injury to the participant. By signing below I am acknowledging my intent to release, waive, and discharge the Academy from any claim or liability for injury to my person or my child/children hereafter occurring at or around the Academy from any cause, whether or not such injury results from the active or passive negligence of the Academy. Accordingly, I, myself, and children, and for my and their successors, personal representatives, and assigns, hereby (I) release and waive any claims and causes of action against the Academy for personal injury, loss and /or consequential damage to me or my children resulting from the future passive or active negligence of the Academy in the operation, management, or supervision of the Academy and (I) agree to indemnify, defend, and hold the Academy free and harmless from any cost, loss, or liability arising out of any injury to myself or my children in or around the Academy proximity resulting from the negligence of the Academy. I further understand that I am not required to do any drill or exercise and can stop any drill at any time. I take responsibility for any training that I undertake. *
Required
Are you 18 years or older? *
Required
By entering your initials here you certify that all information provided is true to the best of your knowledge. *
Your answer
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