FREE TRIAL SIGN-UP

1 **FREE TRIAL SIGN UP*^**

*Please visit the dojo or contact us for enrolment details
^1 FREE TRIAL DOES NOT APPLY TO PRIVATE LESSONS, CONSULTATIONS , RAMADAN ENERGISER BOOT CAMP OR STRIKERS & GRAPPLERS SUMMER CAMP.

Applicant Information

* Indicates required field

Student 1 *

First

Last

Age *

Gender *

Student 2 *

First

Last

Age *

Gender *

Student 3 *

First

Last

Age *

Gender *

Student 4 *

First

Last

Age *

Gender *

Applicant or Parent / Legal Guardian Information (if applying for an individual under the age of 18)

Name *

First

Last

Phone Number *

Email *

Waiver

Terms & Conditions:

1. I and/or Parent/Legal Guardian of the above mentioned student(s) hereby give permission for the applicant to attend Shingikan Martial Arts Dojo's Free Trial.

2. I and/or the Parent/Legal Guardian of the above named student(s), hereby release, waive, discharge, and covenant not to sue Shingikan Martial Arts Dojo, their organizers, teachers, mentors, volunteers, agents, or employees from any and all liability, claims, demands, action, and causes of action whatsoever arising out of or related to any loss, damage, or injury, that may be sustained by the applicant(s), whether caused by the negligence of the releasees or otherwise, while participating in any activity or while in or upon the premises where the activity is being conducted.

3. I and/or the Parent/Legal Guardian of the above named student(s), give permission for transportation and any emergency medical care or treatment to be performed on the applicant by a physician, surgeon, hospital, or medical care facility as may be required, and accept responsibility for the associated costs. (This would only apply when a serious condition exists and staff/medical officials are unable to contact the parent/legal guardian)/close of kin.

By checking the box below *

I agree to the waiver terms above

Name of Waiver Signee *

First

Last

Date of agreement *

PLEASE NOTE WHICH PROGRAM YOU ARE SIGNING UP FOR ! *

Submit

​1 FREE TRIAL SIGN UP*^

1 **FREE TRIAL SIGN UP*^**