Children's Program Registration!


CHILD'S INFORMATION

Number of child:

Child #1
FIRST NAME :
LAST NAME :
DATE OF BIRTH :


PARENT/GUARDIAN'S INFORMATION

FATHER’S NAME:		MOTHER’S NAME:
FATHER’S LAST NAME:		MOTHER’S LAST NAME:
PHONE (Cell/Home):		PHONE (Cell/Home):
OCCUPATION:		OCCUPATION:
EMPLOYER:		EMPLOYER:

BEST CONTACT EMAIL:
ADDRESS :
CITY :
STATE/PROVINCE :
COUNTRY :
ZIP CODE :

MARTIAL ARTS MENTORSHIP

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PARENTS WAIVER

I, NAMED ABOVE, AS A 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 DAMAGE. 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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