KICK'S Class Wavier/Info Form
Wavier Form and Information
Email *
1st. Students Name *
1st Student Date of Birth *
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1st Student Sex
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2nd Students Name (if needed)
2nd Student Date of Birth
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2nd Student Sex
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3rd Students Name (if Needed)
3rd Student Date of Birth
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3rd Student Sex
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Parent or Guardian Name (if under the age of 18) *
Any Physical Limitation We Need to Know About
Please share any previous martial arts training experience you have had (ie, wrestling, mma, karate, etc).
Address *
Phone number *
Consent/Wavier Statement:
I do hereby agree to participate in Martial Arts (referred to as “KICKS Academy”) located at Knightsville United Methodist Church 1505 Central Ave. Summerville, SC 29483. I recognize the risks of injury that are common to any performing arts program that my child or I participate in and I do hereby waive and release KICKS Academy and Knightsville United Methodist Church from and against any and all claims, actions, causes of action, damages, costs, liabilities, expense of judgments, including attorney’s fees and court costs, that arise out of my participation in this program. I hereby execute this Waiver and Release form permitting my minor child and/or myself to participate in the KICKS program.

I understand that the classes are based on a twelve-month calendar year and that tuition for the (years) school session is based on a twelve-month calendar year. Students will average four or more classes per month / per calendar year. Tuition and Testing fees (if eligible) are due and must be paid on or before the first of the month class, or for testing, on the date of testing, regardless of Student’s absence, major holidays, and / or school holidays. I understand that I will receive a courtesy bill reminder, and that tuition not received by the first of each month will assess a late charge, starting at $10.00. Returned checks will result in a $25.00 penalty fee.

I understand that Registration fees, tuition, equipment, camps, and testing fees are non- refundable. I understand that if I wish to terminate membership I will provide KICKS Academy a fourteen-day advance notice before the student’s last class
Uniforms, equipment, camps, testing fees, private lessons, etc. are all additional costs and are not included in with tuition or registration. It is the Parent and/or Guardians or after-school care provider’s responsibility to bring the student into the building and to pick them up. All students must accompanied in and out. Siblings must be monitored and be respectful of Knightsville United Methodist Church facility at all times or will be asked to leave. Parents and family members are welcome to watch classes, but must be quiet and not disturb the students or staff.

1. I acknowledge that the sport of Taekwondo carries with it the potential for serious injury. I acknowledge and agree that it is my responsibility to determine whether I am sufficiently fit and healthy enough to safely participate in Taekwondo, and I attest and certify that I am or will be sufficiently fit and physically trained to participate in any event which I elect to participate in. I have no physical or medical condition which would endanger myself or others if I participate or would interfere with my ability to safely participate.I accept responsibility for the condition and adequacy of the facility the event is being conducted in. I assume responsibility for the condition of my equipment and/or apparel for which I will be participating in.

2. On behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, and anyone else who might sue on my behalf, I HEREBY WAIVE, RELEASE AND FOREVER DISCHARGE ATA, its clubs, event sponsors, staff, administrators, officials, volunteers and any and all other persons or entities involved with an event, including states, cities, towns and other governmental bodies where an event takes place and the officers, directors, employees, agents, insurers, other participants and representatives of all of the above (collectively, the "Released Parties") from any and all claims, causes of action, damages, losses (economic and non-economic), and liabilities of every kind (collectively "Claims") alleged to be caused in whole or in part by the negligence of the "Releasees" or otherwise, including negligent rescue operations, for death, personal injury, or property damage, which may arise out of, result from, or relate to my participation in, or my traveling to or from any sanctioned event, including but not limited to any Claims for theft, damage to any equipment, negligence, partial or permanent disability, Claims relating to providing or failure to provide first aid, medical care, medical treatment, or medical decisions (at an Event site or elsewhere), and any Claims for medical or hospital expenses

3. I acknowledge and ASSUME ALL OF THE RISKS associated with participation in Taekwondo. I acknowledge that the sport of Taekwondo may be dangerous and I understand that I will be participating in any Event at my own risk, that I am responsible for the risk of participation in an Event and that I am waiving and releasing my legal right to sue for any injury or damages arising out of or resulting from my participation in an Event including possible exposure to and illness from infectious diseases (including, but not limited to COVID19). I further understand that any injury or damages incurred may be the result of negligence, omission, or carelessness by the Release Parties.

4. I FURTHER COVENANT AND AGREE NOT TO SUE any of the Released Parties for any of the Claims that I have waived, released, or discharged herein. I AGREE TO INDEMNIFY AND HOLD HARMLESS the Released Parties from any and all expenses incurred, Claims made or liabilities assessed against them, including but not limited to attorney’s fees and litigation expenses, arising out of or resulting from, directly or indirectly, in whole or in part, my breach or failure to abide by any part of this Waiver and Release Agreement, my breach or failure to abide by any of KICKS Academy's Rules, and my actions or inactions which cause injury or damage to any other person.

5.The parent or legal guardian who signs the Waiver and Release Agreement on behalf of a Minor hereby acknowledges that he or she has the legal capacity and authority to act on behalf of the Minor and to legally bind the Minor to the Waiver and Release Agreement. The parent or legal guardian who signs and agrees to the Waiver and Release Agreement agrees to indemnify, and hold harmless the Released Parties for any expenses incurred, Claims made, or liabilities assessed against them, as a result of any injury, death, or insufficiency of legal capacity or authority to act on behalf of the Minor in the execution of the Waiver and Release Agreement.

6. If any provision of this Waiver and Release Agreement shall by unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Waiver and Release Agreement and shall not affect the validity and enforceability of any remaining provisions.

7. I have read this agreement, fully understand its terms, understand that that I (or the Minor's parent and/or legal guardian) have given up substantial rights by agreeing to the terms of this Waiver and Release, and have agreed to its terms freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law.

8. In the event of a medical emergency, I hereby grant authority to authority to a representative of the Church, Michael Murphy, or any adult representative there-of to sign for emergency treatment of myself/my child.
Please type your name below to agree to the waiver. *
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