Karate Class Sign Up

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SHINPU-REN FAMILY KARATE CONSENT FORM

NAME_____________________________________AGE_______DATE__________

ADDRESS_____________________________________________________________

CITY________________________________ST________ZIP_____________

PHONE:HM:____________________________WK:___________________________

1.The member acknowledges that this agreement, including the rules, regulations and conditions set forth by the instructor (SENSEI) are acknowledged. Thus made part hereof constitutes the entire agreement of the parties and that no other agreement exists between them. ShinPu-Ren Family Karate has made no express or implied warranties or representation other than those expressed in this agreement to induce the member to enter into this agreement.

2.Members will be asked to purchase protective gear for their own safety. Member acknowledges that KARATE is a contact sport and that even with protective gear the possibility of injury or death could occur. (INT.____)

3. Members and instructors will not be held liable for injuries occurred during the course of instructions. Furthermore, Member acknowledges that ShinPu-Ren Family Karate is not responsible for loss or injury to any property belonging to any member, or any guest of any member, occurring while the member or guest is in, or about the training facility or premises of ShinPu-Ren Family Karate. The Member agrees to indemnify and hold harmless ShinPu-Ren Family Karate from any and all liabilities, damages and costs incurred, or arising out of the conduct or activity of the Member or any guest of the member.

4. It is understood that there is no cash refund for tuition payment if a student quits during the month or cannot complete training during a month due to debilitating injury, serious illness or death in the family. In these cases a credit for classes will be given in the form of additional classes (not cash value). The credit may be used in the following month. Credits for classes beyond the following month are to be decided by the Instructor. These credit options are to be used only in extreme cases, and at the discretion of the instructors. Students should make every reasonable effort to attend class during the month. If a student abuses these options the Instructor may waive forwarding credits. If a student decides to prepay more than one month at a time, the above policy for refunds and credit applies for any and all month(s) that are prepaid.

Member/Parent or Legal Guardian Signature___________________________Date_____

Emergency Contact PRINT-_________________________________________________

WK:_____________________CELL________________ HM:_____________________

(YES) I release SPRFK to use my photos for school use and purposes

(NO) I do not release SPRFK to use my photos for school use and purposes


Shinpu-Ren Family Karate

6570 E. 6th St.
Prescott Valley
928.308.8001

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