Parent/legal guardian Name: *

First Name

Last Name

Student's Name *

First Name

Last Name

Student's Date Of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Emergency Contact Name *

First Name

Last Name

Emergency Phone *

(###)

###

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Choose participation event: *

Class Trial

Birthday Party

Competition

EFT Outdoor Event

Day Camp

Parents Date Night

Other

1. I understand and am aware that Taekwondo training, strength, flexibility, aerobic exercise, including, without limitation, the use of equipment, are a potentially hazardous activity. I also understand that Taekwondo training and fitness activities involve a risk of injury and I am voluntarily participating myself and/or my child in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death. *

Agree

2. I do hereby further declare myself and/or my child/children to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent participation in the program or use of equipment or machinery I acknowledge that I and/or my child/children have either had a physical examination and have been given physician’s permission to participate in the program or that I and/or my child/children have decided to participate in the program without the approval of a physician, and, in either case, I do hereby assume all responsibility for participation in the program and the utilization of equipment and machinery in connection therewith. *

Agree

3. I also expressly grant Elite Fire Taekwondo or any approved third party of Elite Fire Taekwondo the right to film, videotape or photograph me and/or my child/children and use in any promotional activities to include but not limited to broadcast, television, cable, radio, motion picture, videotape, DVD, CD or any published articles. *

Agree

Disagree

Date *

MM

DD

YYYY