WAIVER AND RELEASE. You (the Parent and Enrollee) agree that you are aware that your child is engaging in a physical exercise, training and instruction, which could cause injury to your child. Your child is voluntarily participating in these activities and assume all risks of injury to your child that might result. You and your child hereby waive any claims or rights you might otherwise have towards the Center, its employees or agents for injury to your child on account of these activities. You have carefully read this waiver and release and fully understand it is a release of liability. You and your child further agree to release the Center from any liability for any loss or theft of personal property. The Center will make no evaluation or recommendation whether Enrollee or guest are sufficiently physically fit for any exercise activities. It is always advisable to consult your child’s physician before undertaking a physical exercise program. Loss/Damage/Theft of Student Property: The Academy does not assume any responsibility for the loss, damage or theft of any property belonging to the student. Buyer and Student agree that the Academy and its personnel are not responsible for or liable for any such property even if its loss, damage, or theft occurs on or about Academy's facility.

MEDIA RELEASE. I grant permission to the Host Organization, North Durham Taekwondo Academy, their officers, officials, agents, and employees, other participants, and if applicable, owners and lessors of premises used to conduct the activities or events (the “Releasees”) to collect the name, photograph, image, likeness, and actions of the Participant, in whole or in part, for promotional, commercial, or other use, in perpetuity worldwide on standard and nonstandard TV, video, print, electronic, and online media (including the internet) and in any other means of distribution, publication or exhibition, whether known or hereinafter created without additional consideration in connection with the Releasees and the marketing, advertising, and promotion thereof.

NOTICE TO PARENTS/ PARTICIPANTS

** Parent fill in all blanks and read all the pages of this agreement before signing.

** Parent certifies that the child is in good health, if not please explain

** Enrollee understands that while all sessions are conducted by a trained instructor with safety in mind there are risks associated with the type of physical contact found in martial arts training and contests.

** Enrollee understands that the sessions involve some physical contact with the instructor or other members, which may at times result in accidental personal injury.

** Enrollee agrees to comply with the Rules and Regulations of the Center which may be given orally or posted in the Center. Continued rules violations may cause summer camp cancelation.

** This agreement comprises the entire agreement pertaining to Summer Camp and no other agreement of and kind will be recognized. Initial here This agreement requires monthly payments by direct withdraw from Parent’s bank account.

This if applicable provision supersedes any conflicting language contained herein. Remarks: Parents Signature: Signed date: ___________________

Evening Training Registration

AddAccountMemberSection

First Name Required	First Name, field is required
Last Name Required	Last Name, field is required
Birthday Required	Month:, field is requiredDay:Year:
Email Required	Email, field is required
Primary Phone Required	, field is required
Primary Phone Type	Primary Phone Type, to switch between list items use arrow buttons. Mobile
Mailing Required	Street City Country ProvincePostal code Canada
Gender	Gender, to switch between list items use arrow buttons.
Additional Emergency Contact Phone
Additional Emergency Contact First Name	Additional Emergency Contact First Name
Additional Emergency Contact Last Name	Additional Emergency Contact Last Name
Additional Emergency Contact Email	AdditionalEmergencyContactEmail
AdditionalEmergency Contact Relationship	AdditionalEmergency Contact Relationship

Parent and Child’s Identification Record

Childs Full Legal Name
Child’s Preferred Name:	Child’s Preferred Name:
Who has legal custody:	Who has legal custody:
Mother’s Name:	Mother’s Name:
Cell Phone	Cell Phone
Home Address:	Street City Country ProvincePostal code Canada
Father’s Name:	Father’s Name:
Cell Phone:	Cell Phone:
Home's Address	Street City Country ProvincePostal code Canada

Gender	Gender, to switch between list items use arrow buttons.

Health Information

Child’s Physician/ Health resource:	Child’s Physician/ Health resource:
Address	Street City Country ProvincePostal code Canada
Child’s OHIP Number:	Child’s OHIP Number:

Phone:	Phone:

Has Child had.

Surgery	Surgery
Burns	Burns
Convulsion	Convulsion

Serious Illness	Serious Illness
Allergies	Allergies

Concern

Any concern

Signature

Signature of Parent