2023 Fall Registration Form
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Email *
Emergency Telephone # *
Student's First Name *
Student's Last Name *
Student's Date of Birth *
Address *
City *
Zip Code *
DOJO STUDENTS:  I understand I am making a financial commitment to an entire semester of classes. WATERMARK & AFTER SCHOOL STUDENTS: I understand I am making a commitment to the 2022/23 season of classes. *
I understand that tuition is a semester fee paid in equal installments – NOT a month-to-month basis. *
I understand installments are due on the 1st of each month, regardless of student's absence, major holidays, and or school holidays *
I understand that I will be liable for the entire semester cost if I cancel or quit classes *
Liability Waiver
GENERAL WAIVER - Black Belts For Christ Ministries, Inc. is insured by the Francis L. Dean & Associates, Inc. Insurance agency. Although all precautions have been taken to insure the safety of all participants, every student must complete this form. In consideration of being allowed to participate in any way in any Black Belts for Christ Martial Arts program, and related events and activities, the participant and parent or guardian: 1. Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating, he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she will immediately advise Black Belts for Christ Ministries personnel of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. 4. Release, waive, discharge and covenant not to sue Black Belts For Christ Ministries, Inc., Watermark homeschool, and their affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees" from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 5. In addition, I hereby grant full permission to any all of the foregoing to use any photographs, videotapes, motion pictures, or any recordings for any purpose. I have fully read and understand this release and waiver.
COVID WAIVER - By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Dojo and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Dojo may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Dojo employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Dojo or participation in Dojo programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Dojo, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Dojo, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Dojo program.
Full Name of Parent/Guardian Submitting this Registration (Same if Adult Student) *
A copy of your responses will be emailed to the address you provided.
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