Adult Registration Form
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Name:
a
Age:
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Address:
a
a
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Phone:
E-mail:
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Waiver
Signed: Method of Payment:
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Waiver of liability
- I ______________________________
being of sound mind and body acknowledge that I am enrolling in a
martial arts school.
- I acknowledge that I am over the age of 18.
- I understand and am fully aware of the fact I will be
involved in a sport involving hitting, wrestling, joint manipulation and
limb extension.
- I understand that these above mentioned acts that can
cause me bodily harm.
- In the event I am injured or suffer any short-term or
long-term physical harm in any way, shape or form, I release Buhler’s
YMCA in Palatine and the Punjabi Cultural Society (PCS), it’s
organizers, promoters, and instructors from any and all liabilities
including but not limited to medical, hospital, paramedic or ambulatory
care.
- I release Buhler’s YMCA in Palatine, the Punjabi
Cultural Society and it’s organizers, promoters and instructors from
any and all injuries including life - threatening trauma and/or death.
- I further acknowledge that
by signing this form, I cannot hold Buhler’s YMCA in Palatine, the
Punjabi Cultural Society and it’s organizer, promoters and/or it’s
instructors liable for any injuries or harm inflicted during practices
or tournaments.
Participant
(Print):______________________________________________
Participant’s
(Signature):____________________________________________________
Dated:
_______________________________________________________