Sports & Fitness . Back to Martial Arts Training (please print)

Children (Under age 18) Registration Form

Name:
a
Age:

Address:

Phone: E-mail

Parent:
a

Waiver Signed: Method of Payment:
a

I __________________________________ Parent of ________________________ am of sound mind and body.
I acknowledge that I am enrolling my child in a martial arts program.
I acknowledge that I am over the age of 18.
I understand and am fully aware of the fact that my child will be involved in a sport that involves: hitting, wrestling, joint manipulation and limb extension. I understand that these above mentioned acts that can cause my child bodily harm.
In the event that my child is injured or suffers 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 on my child during practices or tournaments.

Participant (Print):_______________________________________________________

Parent’s Name (Print) ____________________________________________________

Parent’s Signature: ______________________________________________________

Dated: _______________________________________________________