Registration Fields:
Mentors can create an account by filling out the following information
 
 
FIRST NAME:
LAST NAME:
BIRTH DATE:
AGE:
GENDER:
MALE: FEMALE:
MAILING ADDRESS:
CITY:
COUNTRY:
STATE:
ZIP CODE:
HOME PHONE:
WORK PHONE:
CELL PHONE:
EMAIL:
RELATIONSHIP TO STUDENT:
TEACHER COUNSELOR
RELATIVE FRIEND
SCHOOL:
SOCIAL ORGANIZATION/NON-PROFIT:
FAMILY RELATIONSHIP:
 
Mentor’s Pledge
I understand that I will be playing a vital role in the success of the student(s) I am mentoring. Primary responsibilities include, but are not limited to, arranging for supervised training classes or meetings, monitoring of student usage and level of participation, as well as, communicating with students, parents, and IMA any relative information regarding the status and progress of any given student under your supervision.  The goal is to successfully have all students achieve their martial arts goals in a timely manner in accordance with the program outline.
 
MENTOR WAIVER
I, NAMED ABOVE, AS A MENTOR\PARTICIPANT  PARTICIPATING IN A  TRAINING COURSE WITH INTERNET MARTIAL ARTS.COM (aka - IMA), RECOGNIZE THAT THE TRAINING WILL INVOLVE PHYSICAL ACTIVITIES THAT HAVE RISKS AND INJURIES ASSOCIATED WITH PARTICIPATING IN THIS TYPE OF TRAINING PROGRAM; INCLUDING BUT NOT LIMITED TO THOSE OF BODILY INJURY, PARTIAL OR TOTAL DISABLITY, PARALYSIS, AND DEATH OR PERSONAL PROPERTY DAMGE. I, NAMED ABOVE, FOR MYSELF, MY HEIRS, ADMINISTRATORS, EXCUTORS AND ASIGNEES, HEREBY WAIVE, RELEASE, DISCHARGE, COVENANT AND AGREE THAT I WILL NEVER INSTITUTE ANY DEMAND, CLAIM, OR SUIT AGAINST IMA AND /OR THEIR EMPLOYEES, AGENTS, AND VOLUNTEERS FOR BODILY INJURY, PARTIAL OR TOTAL DISABILITY, PARALYSIS, DEATH, OR PERSONAL PROPERTY DAMAGE THAT MIGHT OCCUR FROM ANY CAUSE WHATSOEVER AS A RESULT OF MY PARTICIPATION IN THE ACTIVITIES IN THE IMA PROGRAM.  I ACCEPT FULL RESPONSIBILITY FOR THE COST OF TREATMENT FOR ANY INJURY SUFFERED WHILE TAKING PART IN THE IMA PROGRAM.
 
I HAVE READ AND UNDERSTAND THE ABOVE.
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