Application for Enrollment

Fields with (*) are required.

*First Name:

Middle Name:

*Last Name:

*Address:

*City:

*State:

*Zip Code:

*Phone Number:

*Date of Birth:

*Gender:

Male Female

Previous Martial Arts Training? Yes No

If yes, where?

Any Medical Conditions? Yes No

If yes, please describe:

Agreement

The undersigned, in consideration of being given instruction in the martial arts of Tae Kwon Do, and being allowed to watch, practice, exercise, demonstrate, or otherwise participate in said martial art or given instruction in the Reis’ Martial Arts Academy L.L.C. of Marshfield, Wisconsin; does hereby irrevocably, personally, and for his heirs, assigns and legal representatives, release and waive any all past, present and future claims, demands and causes of action which the undersigned now has or may in the future have against Reis’ Martial Arts Academy L.L.C. ,and any and all officers, employees, agents, instructors, and/or assistant instructors of the Reis’Martial Arts Academy L.L.C. , for any and all past, present and /or future injuries received as a spectator, participant, contestant or in any other manner or form taking part in the exercise, practice and/or demonstration of said martial art while on the premises of the Reis’ Martial Arts academy L.L.C. of other facilities utilized by Reis’ Martial Arts Academy L.L.C.

The undersigned covenants not to cause any action at law or in equity to be brought, or permit to be brought on his or her behalf, either directly or indirectly. On account of the occurrence of any of the aforesaid injuries against any of the aforesaid parties,and agrees to save, indemnify, hold harmless and defend, from any claims demands, or causes of action which may now or in the future be asserted against the aforesaid parties arising out of actions by the undersigned while engaging in any of the aforesaid on said premises.

*Dated:

*Student Full Name:

If the applicant is under 18 years of age, this application must be signed by his or her guardian or parent who will thereby be bound by all the terms of the application.

Dated:

Parent or Guardian Full Name: