Fremont Shotokan Karate, LLC

Fremont Shotokan Karate, LLC

37428 Centralmont Place, Suite B

Fremont, CA 94536

(510) 794-4430

Black Belt Training Club SIGN-UP

Participant Name / Start Date
Address / E-mail
City Zip / Phone

Payment Plan:

□ Membership fee – one time $5 □ Per class fee $5____

Participant Signature / Student Birthdate
Parent Print & Sign (if applicable) / Date

I understand that the practice of karate of self-defense may involve some physical contact in the form of punching, kicking, joint locking, and grappling techniques. Though qualified supervision is provided, by the very nature of the application of these karate and self-defense techniques, accidents can occur which should cause injury to others or myself if these techniques are performed incorrectly. I will not pursue legal action or hold Fremont Shotokan Karate or its instructors liable if I should suffer an injury during my practice or self-defense, while in the Fremont Shotokan Karate Dojo (school).