enrollment by Cb67vWE5

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									                                   Student Information
                                         (Enrollment Form #1)

Congratulations and welcome to United Fighting Arts Institute, LLC! Your journey into the
martial arts will be one of great personal development. With your membership you are entitled to
all the benefits this academy and the larger martial arts community has to offer. As you will
discover along your martial arts path…your only boundary is yourself. This is your initial step in
self-discovery, enhancement of life and that of the lives of those around you!

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PROGRAM INTERESTED IN

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PRINTED STUDENT NAME                                       DATE OF BIRTH

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MAILING ADDRESS                        CITY                STATE ZIP

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HOME TELEPHONE # CELL #                                    EMAIL ADDRESS

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EMERGENCY CONTACT PERSON                                   PHONE NUMBER

Please tell us a little bit about yourself and why you decided to enroll yourself (or your child) in
the martial arts.
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Please tell us about any medical issues, disabilities or other mental/physical ailments that may
impact your/their martial arts training.
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DATE                SIGNATURE OF PARTICIPANT OR PARENT/GUARDIAN
                                         UFAI Program Rates
                                              (Enrollment Form #2)
TKD/Muay Thai/Fight Team Rates:
      1 Family Member:                $100/12 Month EFT         $105/6 Month EFT           $110/30 Day EFT
      2 Family Members:               $185/12 Month EFT         $195/6 Month EFT           $205/30 Day EFT
      3 Family Members:               $280/12 Month EFT         $290/6 Month EFT           $300/30 Day EFT
      4 Family Members:               $370/12 Month EFT         $380/6 Month EFT           $390/30 Day EFT
      1 Warrior’s Package:            $155/12 Month EFT         $160/6 Month EFT           $165/30 Day EFT

    Warrior’s Package Includes:        (Taekwondo/Thai Boxing/ Fight Team/No Gi/Gi & Aiki Ju Jitsu)

(We Offer a 10% Discount on all programs to: Military/Law Enforcement/College Students & FACH Employees).

Taekwondo Belt Testing Fees (Single Student Rates):
       White – High Yellow: $25.00
       Green – Blue: $40.00
       High Blue – Poome: $50.00
       1st Dan Black: $150.00
       2nd Dan Black: $250.00
       3rd Dan Black: $350.00
       4th Dan Black: $450.00

PAY-BY-CHECK (Single Student Rates):
      $345.00 Quarterly (Check Every 3 Months)
      $660.00 Semi-Annual (Check Every 6 Months)
      $1,260.00 Annual (Check Every 12 Months)

Additional Programs (Single Student Rates):
        Full Time After School Program: $275.00 Per Month EFT (3 or more days per week)
        Part Time After School Program: $245.00 Per Month EFT (2 or less days per week)
        Full Day Camp: $55.00
        ½ Day - Day Camp: $27.50
        Summer Camps: $275.00 Per Week or $55.00 Per Day

Master Ballard’s Private Lessons (Single Student Rates):
        $75.00 Per Hour
        $37.50 Per ½ Hour

Non-UFAI Members Packages:
      $10 Per Open Mat Session / $5 Per Open Sparring Session

No Gi & Gi Program Rates:
       Monthly No-Gi ONLY (No Fight Team or Open Mat):          $55.00 Per Month EFT
       Monthly Gi ONLY (No Fight Team or Open Mat):             $80.00 Per Month EFT
       Monthly Grappling (both/combined w/Open Mat):            $100.00 Per Month EFT
       Private 1/2 hr:                                          $40.00 Check/Cash Only
       Private 1 hr:                                            $80.00 Check/Cash Only
       Saturday Day Pass                                        $40.00 Check/Cash Only


For Kajukenbo Classes Please Contact: Sifu Angel Herrera at: (787)435-4431 or aherrera700@comcast.net
For Kettlebell or Systema Classes Please Contact: Mr. Greg Premo at: gpremorkc@gmail.com
                                 TUITION AGREEMENT
                                         (Enrollment Form #3)

Today’s Date: ____________ Your 1st Payment Will Be Due: ___/___/20___

EFT is “Electronic Funds Transfer”. You may elect to have the payment taken out each month
for that month’s tuition payment transferred directly out of your debit/credit card or bank account to
UFAI, LLC.

Name of Financial Institution: ___________________________________________________

Debit/Credit Card # _____________________________ Exp: _____ CCIV # ____ Type: ______

OR Routing #: __________________________ Acct #: _________________________________

I, the owner of the above listed account; hereby authorize United Fighting Arts Institute,
LLC and/or it’s financial agents to withdraw monthly tuition in the amount of: $___________ from
my account on the date specified above or whichever “business day” lies closest to that date for a
period of 30 days, 6 Months or 12 Months (you must circle one), from the date signed. I am aware
that any/all transactions may take up to 7 “business days” to post to my account. Should my account
information change for any reason, I hereby agree to notify UFAI, LLC within 14 business
days before my tuition due date and complete a new tuition agreement.

I further agree to provide UFAI, LLC with a full thirty days advance notice of my intention to alter
my program package or withdraw from training, after my 30 day, 6 or 12 month period has ended and
before my next scheduled payment is due. If I fail to do so, UFAI, LLC will continue to receive my
regular monthly tuition installment for that month and the following month. I understand that the
account listed above may also be debited by UFAI, LLC for any product purchased or service
rendered that are not listed above; that are explicitly associated with my training to avoid any
additional or late fees that may be assessed. Please note that placing an EFT “on hold” for 1-3 months
is possible but we require 50% of your base tuition monthly to do so and a full thirty days advance
notice of you intent to put EFT on hold or cancel it. No EFT payments can be put on hold for longer
than 3 months. Please note an annual fee of $10 will be debit from each student’s account in the
month of August each year, for martial arts liability insurance. If you or your child trains even for one
day in any given month, you will be charged for the full month’s tuition. I further attest that I am the
lawful OWNER of the account listed above.

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SIGNATURE OF ACCOUNT OWNER                                DATE OF AUTHORIZATION

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PRINTED NAME OF ACCOUNT OWNER
          Release and Waiver of Liability and Indemnity Agreement
                                              (Enrollment Form #4)

In consideration of being permitted to participate in any way in the Martial Arts Program/Gym Wars Event or
Mayhem Event indicated below and/or being permitted to enter for any purpose any restricted area (here in
defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal
guardian(s) of the minor participant named below agree:
1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the
below martial arts activity or event, he or she should inspect the facilities and equipment to be used, and if he
or she believes anything is unsafe, the participant should immediately advise the officials of such condition
and refuse to participate. I understand and agreed that, if at any time, I feel anything to be UNSAFE, I will
immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
2. I/WE fully understand and acknowledge that:
(a) There are risks and dangers associated with participation in martial arts events and activities which could
result in bodily injury partial and/or total disability, paralysis and death.
(b) The social and economic losses and/or damages, which could result from these risks and dangers
described above, could be severe.
(c) These risks and dangers may be caused by the action, inaction or negligence of the participant or the
action, inaction or negligence of others, including, but not limited to, the Releasees named below.
(d) There may be other risks not known to us or are not reasonably foreseeable at his time.
3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such
injury, disability, paralysis or death, however caused and whether caused in whole or in part by the
negligence of the Releasees named below.
4. I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts facility
used by the participant , including its owners, managers, promoters, lessees of premises used to conduct the
martial arts event or program, premises and event inspectors, underwriters, consultants and others who give
recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding
the martial arts facility or events held at such facility and each of them, their directors, officers, agents,
employees, all for the purposes herein referred to as “Releasee”...FROM ALL LIABILITY TO THE
UNDERSIGNED, my/our personal representatives, assigns, executors, heirs and next to kin FOR ANY AND
ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON
ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR
DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE
CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE.
5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve
the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly
acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE
OPERATIONS OR PROCEDURES OF THE RELEASEES.
6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity
agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in
which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall,
notwithstanding continue in full legal force and effect.
7. On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the
minor participant executes this Waiver and Release. If, despite this release, the participant makes a claim
against any of the Releasees, the parent(s) and/or legal guardian(s) will reimburse the Releasee for any money
which they have paid to the participant, or on his behalf, and hold them harmless.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY
AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL
RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT,
ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND
UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Martial Arts School: United Fighting Arts Institute, LLC

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Signature of Participant or Parent/Legal Guardian (if minor)
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Printed Name of Participant
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Address of Participant
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Received by
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Registrar Signature Printed Name Member # Region on File Date

								
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