Future Student Personal Analysis Date ____/____/____ Source________________________Students Name_________________________________ Age______ DOB _____/_____/_____ Home Address________________________________________________________________ City, State,Zip________________________________________________________________ E-mail address_____________________________________________ontact via e-mail? yes / no Home phone #____________________________ Cell phone #___________________________ ***************************************************************************** (Please fill out if student is under the age of 18) Parent Name_________________________________________________________________ E-mail address___________________________________________ contact via e-mail? yes / no Cell phone #___________________________ Emergency phone#_______________________ Parent Name__________________________________________________________________ E-mail address____________________________________________ contact via e-mail? yes / no Cell phone #__________________________ Emergency phone#_________________________ In consideration for my attendance and participation in this martial art, I , the student/parent, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve the school, it’s management, assigned staff, and fellow students, from any liability resulting from personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is a no refund policy on any monies I will pay this school. .Signature________________________________________ Date _____ / _____ / _____ School____________________________ Grade_____ Honor____Avg_____Need extra help___ |