Kickin It Martial Arts Academy LLC – Participant Waiver & Consent
Kickin It Martial Arts Academy LLC (KIMAA) • One form per child or adult participant
Participant
First Name
*
Last Name
*
Contact & Emergency
Email
*
Mobile Phone
*
Emergency Contact Name
*
Emergency Contact Phone
*
Allergies / Medical Notes
Media Consent
Opt In
— photos/videos may be used publicly and internally.
Opt In to Private Social Media and Internal Advertising
— limited to private social media spaces and in-facility displays only.
Opt Out
— no photos/videos anywhere.
Assumption of Risk & Liability Release
I, the undersigned parent/guardian
or participant (if 18+)
of the above-named student (“Participant”), understand that martial arts and related fitness activities involve inherent risks of injury. I voluntarily assume all such risks for Participant and agree to release and hold harmless Kickin It Martial Arts Academy LLC (KIMAA), its owners, staff, agents, volunteers, event partners, venues, and sponsors from any and all claims or liability for injury, illness, or property damage arising from participation in classes, events (including off-site activities such as community days and water-balloon events), practices, or demonstrations, whether caused by negligence or otherwise, to the fullest extent permitted by law.
I authorize KIMAA personnel to obtain emergency medical care for Participant if I cannot be reached.
Signer Information
Printed Name (Parent/Guardian or Adult Participant)
*
For adult participants, enter your own name.
Date
*
I have read and agree to the Liability Release above and certify the information provided is accurate.
I certify that I am the parent/legal guardian or the adult participant, and the signature below is mine.
Signature
*
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