Adult Program Registration!


 
FIRST NAME:
LAST NAME:
WEIGHT: lbs.
HEIGHT: feet inches
SHOE SIZE:
HAT SIZE:
BIRTHDATE:
AGE:
GENDER: MALE FEMALE
MARITAL STATUS: SINGLE MARRIED
PHONE (H) (ex. 9071234568):
ADDRESS:
CITY:
COUNTRY:
(please select country first, then state)
STATE:
ZIP:
EMAIL:
CEL. PHONE: (ex.) 9071234568
SCHOOL AND GRADE LEVEL:
OCCUPATION:
EMPLOYER:
PHONE (W): (ex.) 9071234568
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RESPECT    
STUDENT WAIVER
I, NAMED ABOVE, AS A PARTICIPANT OR AS PARENT OR LEGAL GUARDIAN OF A PARTICIPANT   ENROLLED AND 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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