Waiver of Liability
Isshinryu Karate LLC & Kent Karate and Family Fitness
    I (Student's Name) _____________________________hereby for myself, executors, and my heirs, waive and release any and all rights and claims for damages I may have against the instructor(s) for injuries which may be suffered as a result of instruction and training of karate/kung fu or other classes offered by the academy/school at Kent Karate and Family Fitness’s dojo.

I understand that my participation in the physical abilities shown in this course is at my discretion and I am expected not to exceed my own physical limitations. I will inform the instructor(s) of any and all history of medical disabilities and conditions I suffer or have suffered I understand that my participation in the karate/kung fu training or other physical training is voluntary and involves a wide variety of risk. This is a "hands on" program where other members of the class and myself will be simulating attacks on each other and executing defensive moves to simulate self-defense.
           
In order to properly teach and instruct this class it may be necessary for participants and instructors to physically engage each other, including but not limited to physical contact. If, for any reason, you and this contacts be unwelcome, uncomfortable, or intrusive, please notify the instructor immediately Please consult a physician before beginning this or any other exercise program. The activities, physical or otherwise, involved in this may be too strenuous for some and could result in injury. If you develop any pain or abnormal symptoms during, or resulting from this program consult your doctor 

_______Please initial here that you've read and understood the above information.
Please notify the instructor(s) of any and all medical conditions that may affect your ability to participate if this class or program.
              
I hereby, for now and forever accept any and all responsibility for my actions in conjunction with said class and the use of the training I receive in these classes.         

Name (Parent/self)_____________________________________________________________________ 

Address      _________________________________________________________________________    

City/state|/zip _________________________________________________________________________  

Home Telephone __________________ Cell Phone   ________________________

Email___________________________________ DOB (Student)  _______________________________ 

_____________________________________________________________________________________                                                                                                                       Signature of Student/participant (or parent if under the age 18)   Date