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Waiver

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Gender

Date of Birthday

YYYY

Phone

(###)

###

####

Physical limitations

How did you hear about our school?

Why do you want to learn martial arts?

EMERGENCY CONTACT

I understand that I must comply with all Dojo (training facility) rules and regulations, which are set up for the protection for the students form injury. I understand that I am accepting full legal responsibility for any of my acts or any injury I may receive at the school, in transit to and from, at demonstrations, tournaments, or any other sanctioned event. Further, I hereby release Renzo Gracie Garwood, its instructors, employees, agents, members and authorized guests from any liability while training at the school or any school function. I also understand that tuition is due on the first day of the month, unless alternate arrangements have been made with the owner. Also, I understand that I am personally liable for the amount of tuition due for said month, or months. In consideration of acceptance of the above named applicant into this facility and recognizing the risk involved in practicing the martial arts, undersigned parent, guardian, or hereby agree to save, indemnify and keep harmless RENZO GRACIE GARWOOD, its instructors, employees, agents, members and authorized guests against any liability claims judgments or demands from damage arising accidents or injuries of above named applicant. Parent's approval and signature is required from all students under eighteen (18) years old.

Student name if under 18:

By checking this box, I agree to the above terms and conditions.

Date

YYYY