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Karate Release Form


Gateway -Page 1of 2Texas Okinawa Goju Kai Karate FederationAustin Okinawan KarateThe student acknowledges the existence of certain inherent risks in the martial arts type of training and hereby agrees

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Document on Subject : "Karate Release Form"— Transcript:

1 Gateway - Karate Release Form P
Gateway - Karate Release Form Page 1 of 2 Texas Okinawa Goju Kai Karate Federation Austin Okinawan Karate The student acknowledges the existence of certain inherent risks in the martial arts type of training, and hereby agrees to assume all risks himself/herself. The student has permission from t heir health care provider(s) to participate in this type of activity. The student further relieves the Texas Okinawa Goju Ryu Karate Federation, Austin Okinawan Karate, Okinawa karate schools, N.Y.O.S., Gateway Charter Schools, their management, assigned instructors, assistant instructors, affiliated facilities, affiliated organizations, and fellow students from any liabilities resulting from personal injury and/ or loss of personal property. In case of accident to a minor, the parent indemnifies the above mentioned for any damages sought by or on behalf of the student. The student acknowledges that rules and regulations governing the schools and the federation have been adapted and may be changed from time to time. The student agrees to abide by all such rules and regulations adapted; including the times scheduled for instruction, method of instruction, method and date of payment and use of facilities as noted by the chief instructors and instructors of the respective school. The student understands he/s he must instruct as a part of their training and agrees to do so without compensation. All funds provided to Austin Okinawan Karate are to be considered non - refundable. The student and/or guardian agree to allow pictures and or video of themselves to be used for advertisement, magazine articles, and video material without compensation. *****The student hereby stipulates that he/she is physically sound and that he/she has medical approval to proceed with this ty

2 pe of training.***** Statement: I p
pe of training.***** Statement: I promise to use karate only in self - defense, in defense of helpless persons, in defense of my country, or in a matter of honor. Date:_________________________ Student Signature : _______________________________________ Parent or guardian co - si gnature:______________________________________________________ Relationship:___________________________________________________________ Student Name sex date of birth age Address City, State zip Parent Home phone Parent mobile phone Parent e - mail address List any of student ’ s previous martial arts training and rank achieved (you may attach another page if needed) What is student ’ s main interest in studying karate. How did you hear about or find us. (example: walk up, advertiseme nt, word of mouth, etc.) *!*!*Please see second page for tuition and annual fee payment agreement.*!*!* Gateway - Karate Release Form Page 2 of 2 Annual Fee and Tuition Schedule Membership in Austin Okinawan Karate requires an annual fee of $35 per year. The year is considered to include part or all of the last three sessions of the current year and the first three sessions of the coming year. The fee is normally collected during the fall registration time. Tuition for each session is $125, and is due TO THE INSTRUCTOR by the first class of each six week session and is considered late after midnight on the fifth day following that day. I understand the late fee for tuition is $10 per student. Date:____________________________________ Printed Name:________________________________________ Signature:________________________ ___________________