Student Name

Please complete and sign this form prior to participating in classes or fitness programming at ‘Ohana Martial Arts. Completed forms must be submitted online. We are eliminating paper form by 2020.

First Name

Last Name

Student Age and Grade Level if Applicable

Parent/Guardian Names

• Does the participating student have any medical conditions we should know about that would affect their ability to participate in an age appropriate self-defense training? Hosting school will handle any medical emergencies using their own protocols and information you have provided the hosting school.

Email Address

Would you like to receive emails about future dojo happenings?

Yes

I already get emails

Permission to use images of your student 'Ohana Martial Arts is authorized by to use video or photographs of you student for advertising, publicity and public relations. Video-footage will only be used by 'Ohana Martial Arts Non-profit Self-defense School. No further claims may be made. If there is a court ordered safety issue with use of photos/videos such as foster children please let us know in advance.

Agree

Agree - but please try not to use by students image due to personal circumstances. Please note use of images in public settings is not illegal, but we try to honor your request.

Full Responsibility Waiver I, _____________________________, take sole responsibility for any personal injury I (or my participating family members) may incur over the course of any and all 'Ohana Martial Arts programs we may participate in. I acknowledge that participation in this program exposes me to potential risks and I release all instructors or fitness coaches from any and all liabilities regarding an injury and will cover all medical costs associated with injuries from participation. I shall not now or in the future prosecute any lawsuit against 'Ohana Martial Arts non-profit self-defense school or its directors, board of directors or instructors. I’m aware that this agreement will be legally binding. I have read and understood this Injury Waiver and Medical Release Form as a participant or a parent/guardian.

Agree

I understand that there are risks in attending fieldtrips and me or my family may be inadvertently exposed to illness, including COVID. ‘Ohana Martial Arts follows all laws and regulations. I release 'Ohana Martial Arts, all instructors or fitness coaches from any and all liabilities regarding illness, closures and will cover all medical costs associated with illness from participation. I shall not now or in the future prosecute any lawsuit against 'Ohana Martial Arts non-profit self-defense school or its directors, board of directors or instructors. Students and staff with active cold symptoms are not allowed at field trips.

Agree

Participant Signature or Participants Parents/Guardians Signature if student is under 18 I Sign and Agree to all terms of this form and waiver. I understand 'Ohana Martial Arts Non-Profit Self-Defense School is an equal opportunity organization and does not deny enrollment or discriminate based on race, color, religion, gender or national origin. I understand it is my responsibility to update this information if changes occur to my or my child's health. I understand that by typing my name where indicated below, I consent to the use of electronic records and signatures in the manner described above, and the electronic storage of such documents.

Feild Trip Location

Location: PO Box 1805 Kailua-Kona HI 96740

Phone: (808)494-2346

Email: ohanaselfdefense at gmail dot com

Images and Website by Tara Brown all rights reserved