Robinson's Taekwondo Class Schedule

CONSENT FORM

Name _______________________________________________ Age_______________

Address ____________________________________________________________________

City ______________________________________ State__________ Zip______________

Phone (Home) ______________________________ (Work) _________________________

PROGRAMS

Circle One	Beginning Date	Expiration Date
One Time Visit	________________	________________
2 Week Special
30 Day Pass
Buddy
Other_____________________

Notice - ATA, Karate for Kids, Taekwondo USA, and Robinson's Taekwondo Inc. urges all member and guests to obtain a physical examination prior to the use of any fitness equipment or attendance in any martial arts class. In recognition of the possible dangers connected with any physical activity, member(s) or guest(s) hereby knowingly and voluntarily waive any right of cause of action of any kind whatsoever arising as the result of such activity from which any liability may or could accrue ATA, Karate for Kids, Taekwondo USA, and Robinson's Taekwondo Inc., its officers, agents, employees or instructors.

Signature _______________________________________ Date ______________________

The undersigned certifies that he/she is the parent or guardian of the minor named as member/guest herein. As such parent or guardian, the undersigned acknowledges that he/she understands the risk of injury inherent in any vigorous activity, and on behalf of member/guest assumes such risk.

Parent/Guardian Signature _________________________ Date ______________________