Waiver Form – Wilde Lake Karate

Parent Name *

First

Last

Mother, Father or Guardian

What is your relationship to your child. Mother, father or guardian? *

Parent Name

First

Last

Mother, Father or Guardian

What is your relationship to your child. Mother, father or guardian?

Student Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Email

Confirm Email

1st Child Name *

First

Last

Date of Birth *//

2nd Child Name

First

Last

Date of Birth//

3rd Child Name

First

Last

Date of Birth //

waiver and release of Liability, Assumption of Risk,Indemnification, discipline policy,Consumer Rights and Membership

I understand that there are numerous risks associated with the participation in activities at the Summer Camp- Before & Afterschool Program, martial arts, gymnastics, soccer, basketball, bowling, swimming, skating, as well as other sports, amusement rides, slot car racing, and attendance at water parks and animal shows and any other activities that the Wilde Lake Karate & Learning Center (“WLK”) participates in with my child. I acknowledge that any and all of these risks are inherent in these activities and that these activities, and other activities in which my child might engage in pose the possibility of severe injury, illness, and other risks that cannot be eliminated, altered, or controlled. I also acknowledge that motor vehicle accidents may occur in the course of transporting camp participants to or from activities. or during before & after school transportation, summer camp, or day camp field trips. I give permission for my child to participate in all Summer Day Camp, before-after, day camp school activities, and any activities provided through WLK including, but not limited to those described above and in the weekly schedule. I acknowledge and assume the risks involved in these activities and for any damage, illness, injury, or death resulting from such risks to myself and my child. I confirm that there are no physical, emotional, or mental problems or limitations associated with my child's participation in summer camp before and after school and all other activities, except as disclosed by me in writing to WLK. RELEASE, WAIVER OR LIABILITY, AND INDEMNIFICATION: In consideration of my child being permitted to participate in WLK’s Summer Day Camp, Day Camp, Before & After School Program I, on behalf of myself and my child, do hereby release and forever discharge Wilde Lake Karate and Learning Center, Inc., its officers, agents, representatives, and employees, of and from all manner of actions, suits, claims and demands whatsoever, in law or in equity, with respect to any injury, illness, damage, or death occurring to my child while he or she participates in any and all camp programs and activities. I hereby agree to indemnify and hold harmless Wilde Lake Karate and Learning Center, Inc. and its officers, agents, representatives, and employees, with respect to any claim asserted by or on behalf of my child as a result of property damage or personal injury, illness, damage or death, which indemnity and holding harmless includes any attorney's fees and costs. I have read and understood the above and agree to be bound by the terms of this document. Authorization and Waiver: I hereby authorize WLK to act on my behalf in an emergency requiring medical attention or any other humane action. I hereby waive and release WLK from all liability for any injuries or illnesses incurred. I understand that participation in summer camp, before and after school program (martial arts classes), and all other activities inside and outside WLK involves physical activity and as such carries with it the risk of injury. Should an injury occur, all medical expenses incurred are the sole responsibility of the participant or participant’s family, this includes all activities inside and outside this facility. I authorize and give permission for the Ride Form Authorization of Transportation. I hereby authorize WLK to transport my child to all activities. If I elect NOT to have my child participate in a particular activity, I will notify the school in writing of my decision. Furthermore, I will make alternative arrangements for my child for the duration of the planned activity. I have documented below all precautions and instructions regarding my child’s medication. I have noted any special Health-related conditions or allergies regarding my child. I agreed to all the above waiver of liabilities by signing my name of this liability waiver for WLK. I agreed to WLK’s SCHOOL DISCIPLINE POLICY as below. WLK’s Martial Arts After School Program is a program based on the contract between parents and legal guardians and their children for taking martial arts classes. To maintain a safe and qualitatively sound program, we occasionally find it necessary to apply our discipline policy. We feel that effective and positive methods of behavior management are: (1) REDIRECTION: We will stop the child and calmly learn what has happened, why, and how they see the issue, and then suggest other ways of handling the situation. Then, we will redirect their attention. (2) SEPARATION: We will have the child play apart from the rest of the group and rest for a short time. This allows them to calm down. Then we will explain other ways of good behavior. (3) If a child's behavior remains problematic, a parent conference will be held. If there is little or no improvement in the child's behavior after the parent conference, termination of enrollment may become necessary. Termination of enrollment will be at the discretion of WLK’s staff. Notice of Consumer Rights: Our Health club registration number is (--E 2929----). The school is not required to carry a performance bond under Maryland law since we don’t collect more than three month’s payment in advance or $200.00 in initiation fees. You have the right to cancel this agreement within three (3) business days (including Saturday) after the date this contract is signed. Cancellation must be in writing. After three (3) days all new students are under first six (6) months of membership and all current students under monthly membership, in case current and new students after six (6) months need to cancel their membership, they must give thirty (30) days written notice. Please below type your name and write I agree. *

By Sign below I agree to all terms of Wilde Lake Karate & Learning Center INC waiver and release of Liability, Assumption of Risk,Indemnification, discipline policy,Consumer Rights and Membership *

By Sign below I agree to all terms of Wilde Lake Karate & Learning Center INC waiver and release of Liability, Assumption of Risk,Indemnification, discipline policy,Consumer Rights and Membership (copy)

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Date

Time

waiver and release of Liability, Assumption of Risk,Indemnification, discipline policy,Consumer Rights and Membership

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