"*" indicates required fields Krav Maga Student Information and Liability WaiverName First Last Plan Type Address Address Line 2 City Postal Code Email Mobile Phone NumberDate of Birth* YYYY dash MM dash DD Medical conditions No Yes Please specify:Would you like to add a 2nd student? No Yes Krav Maga Student #2 InformationName First Last (only complete if different than first applicant) Address Address Line 2 City Postal Code Email Mobile Phone NumberDate of Birth* YYYY dash MM dash DD Medical Conditions Student #2 No Yes Please Specify:Would you like to add a 3rd student? No Yes Krav Maga Student #3 InformationName First Last Address (if different from other applicant) Address Address Line 2 City Postal Code Email Mobile Phone NumberDate of Birth* YYYY dash MM dash DD Medical Conditions Student #3 No Yes Please Specify:Would you like to add a 4th student? No Yes Krav Maga Student #4 InformationName First Last Address (if different from other applicant) Street Address Address Line 2 City Postal Code Email Mobile Phone NumberDate of Birth* YYYY dash MM dash DD Medical Conditions Student #4 No Yes Please Specify:Are any of the applicants minors?If the applicant(s) is a minor then a parent or guardian will need to sign on their behalf.The applicant is a minor No Yes Parent/Guardian - InformationComplete if the applicant is a minor.Name* First Last Primary Contact Yes No Mobile PhoneEmail* Would you like to specify a separate emergency contact? No Yes Emergency ContactName First Last Email* PhoneRelation to applicant Terms and Conditions I understand that Krav Maga classes, seminars, camps for youth or adults as well as other Krav Maga activities can be dangerous, but I am voluntarily choosing to participate in some or all of these activities and agree to assume the risk associated with my participation therein. I understand that I am assuming full responsibility for any and all risks of death, personal injury, emotional pain and suffering, property damage and economic loss that might be suffered by me as a result of my participation in these activities and classes. I hereby further agree to release, indemnify and hold completely harmless the Krav Maga organizers, instructors and volunteers of the Krav Maga activities, classes and all other entities associated with them and independent contractors harmless from any and all liability and costs, including attorney fees, associated with or arising from my participating in the activities and classes, waiting at or on premises to participate in such activities and classes or waiting at or on premises for others who are participating in such activities and classes, and walking through the premises prior to or after such activities and classes. I accept that: There are no refunds for classes or other activities such as camps and seminars, The pre-authorized payment plan will be used for regular class payment where my credit card will be charged on the 1st of each month, If I take classes for longer than one month I will acquire a Krav Maga Nation t shirt as well as any required equipment etc, In the event that a class is canceled I will take one of the other scheduled classes available, Pictures of me may be used to advertise Krav Maga Nation activities in various media. If I am signing this release on behalf of a minor child, I understand that I am giving up the same rights for the said minor as if I signed this release on my own behalf. Agreement* I have reviewed and accept the Terms and Conditions PhoneThis field is for validation purposes and should be left unchanged.
