Bring Mom Class 5_Fathers_Day Date : Saturday, June 20th Address: 1455 Youville Drive, Unit 114, Orleans, ON Select an option * OPTION_1 : 12:30 to 1:00 pm for Little ninjas 3-5 years old OPTION_2 : 1:15 to 1:45 pm for 6-12 years old all belts OPTION_3 : If you participate in both OPTION_1 and OPTION_2 Number of children participating * 1234 Child - 1 * Child - 1 First Name First Name Last Name Last Name Child 1 - Date of birth * Child 1 - Age Child - 2 * Child - 2 First Name First Name Last Name Last Name Child 2 - Date of birth * Child 2 - Age Child - 3 * Child - 3 First Name First Name Last Name Last Name Child 3 - Date of birth * Child 3 - Age Child - 4 * Child - 4 First Name First Name Last Name Last Name Child 4 - Date of birth * Child 4 - Age Dad's Information Dad's name * Dad's name First Name First Name Last Name Last Name Dad's Date of birth * Age Phone * Email * Waiver of liability Paragraph * I warrant that I am in good health and that I am not aware that I have any health problems other than those I have indicated. I attest that I have no physical, psychological, medical or emotional condition that would prevent me from safe participation in any of the Orleans Taekwondo Academy classes and training. The Licensee and the Licensor are not responsible for any loss or damage suffered by any person before, during or after the lessons, or any activity I am involved in with the schools of the Licensee and the Licensor for any reason whatsoever, including negligence on the part of the schools of the Licensee and the Licensor, its agents or servants. I assume all risk of injury and hold Orleans Taekwondo Academy and its instructors harmless of any injuries suffered to the student, arising out of activities involving taekwondo or any class variation thereof whether occurring on the premises of training or elsewhere. The student agrees to abide by all the rules and safety regulations of the school and to all instructions given by our instructors. I agree to assume all risks involved in participating in the March Break camp, including before and after, and agree to pay the cost of any emergency evacuation of my person and belongings that may become necessary. I agree to that the Licensee and the Licensor, their agents and servants, being relieved of all liability for losses and damages of all and every description. In the event of an emergency, the student/parent/or guardian give permission for emergency first aid to be administered or emergency medical help be called by the representatives of Orleans Taekwondo Academy. Only first aid will be administered, and the students/parents or guardians will hold Orleans Taekwondo Academy harmless. Reasonable attempts will be made to contact the parents, guardian or emergency contact, in the event of failure to reach someone, Orleans Taekwondo Academy will act on their behalf. In case of a medical emergency for the best medical interest of the student I agree to abide by the rules and safety regulations of Orleans Taekwondo Academy. I recognize that this agreement of release and waiver of liability is a legally binding agreement and that I understand all the terms provided in this Agreement. I further acknowledge and understand that by signing this agreement, I completely forego all my legal rights to make any claims against Orleans Taekwondo Academy. I, and my legal representatives, successors and assigns, HEREBY RELEASE AND DISCHARGE Orleans Taekwondo Academy and its administrators, directors, officers, volunteers, instructors, employees and staff, of and from all liabilities, claims, causes of action, losses, and damages in anyway whatsoever arising from or related to the loss, theft or damage of any of my personal property from the Orleans Taekwondo Academy premises. I agree that there is no representation, warranty, collateral agreement or conditions affecting this agreement other than as expressed herein in writing. I ACKNOWLEDGE HAVING READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT, ASSURANCE OR UNDUE INFLUENCE OF ANY KIND. I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL ASSUMPTION OF THE RISKS OF THE ACTIVITIES AND A WAIVER AND RELEASE OF THE LIABILITIES OF THE RELEASEES (Orleans Taekwondo Academy) You are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By signing here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary. Signature signature keyboard Clear Name of signatory * Date of signature * Submit If you are human, leave this field blank.
