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Family Martial Arts

Bushido Martial Arts

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Waiver

Martial Arts Participation
Liability Waiver

First name

Last name

Email

Date of Birth

Do you have pre-existing limitations or injuries?

No

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Phone

Thanks for submitting!

Tel: (401) 484-2337 Email: bushidopartners@gmail.com

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