Jarrettsville Tae Kwon Do

I, _______________________________________________________________, (print name), desire to actively participate in the Jarrettsville Tae Kwon Do program.  I agree to follow all of the rules and regulations that are set forth in this program and by its instructors.  I understand that Jarrettsville Tae Kwon Do gives instructions in self defense.  I understand that the practice of martial arts involves some risk, and I may become injured as a result of the instruction and practice offered by Jarrettsville Tae Kwon Do.  In consideration of the instructions given, and in order to be accepted as a member, I do hereby release and discharge Jarrettsville Tae Kwon Do, its instructors, agents and students from any and all actions, claims or other liabilities which may exist or arise hereafter, directly or indirectly resulting from any student, senior student, instructors or agents of Jarrettsville Tae Kwon Do, for any willful or wanton acts committed by other students, regardless of location.

Student Seal _________________________________________________      Date_______________

Student Seal _________________________________________________      Date_______________

Student Seal _________________________________________________      Date_______________

Legal Guardian _______________________________________________      Date_______________