Enrollment Procedure

Registration

Your Name(Required)

First Middle Last

Age(Required)

Date of Birth(Required)

Place of Birth

Gender

Male

Female

Marital Status

Single

Married

Your Address

Street Address City ZIP Code

Occupation

Phone

Medical Condition

Rank

Previous Training

School Attended

Contact (Parent/Guardian)

Date of Start

Consent(Required)

I agree to the Terms and Conditions

PACIFIC ALLIANCE OF MARTIAL ARTS

In consideration of acceptance of this application. I/We, the undersigned, intended to be legally bound, hereby, for myself, my heirs, executors and administrators, WAIVE AND RELEASE ANY AND ALL CLAIMS FOR LOSSES AND DAMAGES I/WE may have against PACIFIC ALLIANCE OF MARTIAL ARTS, and all other parties and their representatives, successors and assignees for any and all injuries suffered by member* while in the course of receiving lessons, instructions, or participating in contests/events involving the martial arts whether on or off the PACIFIC ALLIANCE OF MARTIAL premises/studio. I/WE the undersigned understand and acknowledge that lessons, instruction and contest/events in the martial arts may subject the member to strenuous physical and/or mental exertion and physical contact which may result injury or death to member. I/WE, the undersigned, expressly assume all such hazards and risks of injury to member, which may result directly or indirectly from lessons, instruction, or contests/events in the martial arts. I/WE promise that in the event member becomes unable to participate therein, because of physical and/or mental impairment, member will immediately notify PACIFIC ALLIANCE OF MARTIAL ARTS in writing of the same. NO CLAIMS FOR REFUND OF ANY AMOUNT will be made by reason of absence or withdrawal from PACIFIC ALLIANCE OF MARTIAL ARTS.
Release Agreement and Waiver of Personal Injury Claims
You (or your parent of guardian) acknowledge that the study of Martial Arts is inherently dangerous, and physical injury may result from participation in such activity.
Initial: You hereby expressly and fully assume all risk of injury from such participation, and, on behalf of yourself, heirs, representatives, and assigns, hereby fully release and discharge Pacific Alliance of Martial Arts, it's owner, instructors, employees, students, and any of their representatives from all liability for any injuries (including death) from such participation, including by way of illustration. Participation includes traveling to, participating in, or returning from any special events, locations and tournament.
Initial: If you are under age of 18 years, your parent or guardian further agrees to defend and indemnify the parties released hereby for any claims for injuries of the minor student.
Initial: If you are under age of 18 years of age, the signature of the parent of guardian below also authorizes the owner and/or instructors of Pacific Alliance of Martial Arts to act in their behalf regarding the authorization of medical treatment for you in the event of injury during practice, competition, or transportation.
Initial: I understand that any pictures of me and/or the minor child participating in the course may be used for publicity purpose without compensation.
Initial: You, (or your parent or guardian) hereby releases the school from responsibility for injuries arising out of aggravation or pre-existing conditions.