Tigers’ DomainRegistrationForm

Karate Classes

StudentName:
Parent/GuardianName (if under 18)

Methodforpayment:Checks Money Order Cash

Make Checks or Money Orders payableto:Tigers’ Domain

Mail Registration and Fees to: Tigers’ Domain C/O Wendell John, 4755Planters Ridge Drive, Tallahassee Florida 32311

Terms of Agreement and EnrollmentObligations

1.StudentandparentsagreetofollowandrespecttherulesandregulationssetbytheMasterInstructor(ownerofschool) orSchool Director for thesafety,welfareandhappinessofALLstudents.

2.Thestudentandparentorguardiancertifiesthatthestudenthasnophysicallimitationsthatwouldpreventthestudent fromparticipatinginallinstructionandactivities.

3.Tigers’ Domainisnotresponsibleforthestudent’sequipmentorpersonalbelongingsatanytimethattheyareunderoursupervision.Thisincludeswhenwearetravelingtoandfromspecial events,andatalltimesweareinthe building;includingfire,theft,anddamageofanykind.Theschoolwillprovidepropersupervisionsodamageandlossesare kept to aminimum.

4.TheMaster Instructorreservestherighttoexpel,suspend,deny,orcancelanystudent’senrollmentinourclassesatany timeshouldhedeemitnecessaryforthebestinterestofthestudentortheprogram.Inthiscaseanyunused feeswill NOTberefunded.

5.All registration fees and paid class fees arenon-refundable.

Tigers’ Domainreservestherighttouseanylikenessofits studentsforfuturepromotionalpurposesinprintedliterature,

videos,andonourwebsite,withnomonetaryorothercompensationtobepaidorbilled.

Liability, Assumption of Risk, Indemnification and Release

Liability:EachstudentofTigers’ Domainshallbepersonallyresponsibleforanypersonalinjurycausedbythestudent,student’sfamilyorotherstudentwhichwhendamageorinjuryoccursattheschool,oronanyequipment,orat anyfacilitiesthestudentisatwhileinourcare,andanyprograms.Theparent/guardian of the student or the student if age 18 or olderwillpromptlypayTigers’ Domainfor anyandallpropertydamageafterareplacementorrepairhasbeenprocured.

AssumptionofRisk:Theuseofanyequipment,apparatus,facilities,swimmingpool,livestock,orservices,ownedand operatedbyTigers’ Domain,orinusefortheKarate classesisundertakenbythestudentand/orfamilymember atsuchperson’sownrisk,andTigers’ Domainshallnotbeheldliableforanyinjury,death,ordamagestoanysuch person,tothepropertyofsuchperson,orbesubjecttoanyclaims,demands,ordamagesresultingfromsuchuse.

Indemnification:Eachstudentagreestoindemnify,holdTigers’ Domain,itsagentsandemployees,freeandharmlessfromalldamage,suits,liability,costsandexpensesincurredinconnectionwiththeuseofanyapparatus,equipment, facilitiesandservicesoftheschool.

Release:EachstudentherebyreleasesTigers’ Domainfromalldamage,suits,liability,costsandexpensesincurredin connectionwiththeuseofanyequipment,apparatus,facilities,andservicesofTigers’ Domain.BindingEffect:The aboveprovisionsarebindinguponthestudent,thestudent’spersonalrepresentative,successorsorassigns.

StudentSignature: Date:

Parent orGuardian’sSignature: Date:

Applicationisnotvalidunlesssignedandreturned

YouMUSTfillout a separateRegistrationForm andStudentInformationFormfor each childyouregister.

407-460-5681

Student Information

Student Name: ______

Address: ______

City: ______

Phone: ______

In case of an emergency contact: ______

phone:______

E-mail address: ______

Birthdate: ______

Uniform size: ______

Has student had any prior training at another school? If so,

Previous martial art style: ______

Level (rank) achieved: ______

Name of school: ______

Why are you interested in training in the martial arts?

______

______

______

Billing Information

Name: ______

Address: ______

City: ______

Phone: ______

I, ______, hereby agree to the following:

  1. That I am participating in the martial arts classes, programs, and workshops offered by Tigers’Domain Martial Arts Academy during which I will receive information and instruction in and about various martial arts. I recognize that martial arts programs require physical exertion and physical contact that may be strenuous and may cause physical injury, and am fully aware of the risks and hazards involved.
  2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any martial arts classes, programs, or workshops. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the martial arts classes, programs, or workshops.
  3. In consideration of being permitted to participate in martial arts classes, programs, or workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.
  4. In consideration of being permitted to participate in martial arts classes, programs or workshops, I knowingly, voluntarily and expressly waive any claim I may have against Tigers’Domain Martial Arts Academy for injury or damages that I may sustain as a result of participating in the program.
  5. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue Tigers’Domain Martial Arts Academy for any injury or death caused by my participation in any martial arts classes, programs, or workshops.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

______

DateSignature of Participant

If participant is less than 18 years of age:

As legal guardian of ______, I consent to the above terms and conditions.

______

Date Signature of parent/guardian

Witnessed by:______

407-460-5681