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North Shore Jiu-Jitsu Kids Club_ Inc

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					North Shore Jiu-Jitsu Kids Club, Inc.
2604 El Camino Real #b299
Carlsbad, CA 92008

Classes held at :
Pupuke Recreational Center
Kam Hwy
North Shore, Oahu, Hawaii

DATE:________________

PARTICIPANT’S NAME:_______________________________
                   please print

Participants Address: _____________________________

                      _____________________________

Emergency Contact:________________________
                  please print

Phone: _______________________


WAIVER AND RELEASE OF LIABILITY: the club urges you and all participants to
obtain a physical examination from a doctor before using any exercise equipment or
participation in any exercise class. All exercises, including the use of weights and use of
any and all machinery, equipment, and apparatus designed for exercising shall be at the
participant’s sole risk. Participant understands that the agreement to use, or selection of
exercise programs, methods and typed of equipment shall be member’s entire
responsibility, and the Club shall not be liable to member for any claims, demands,
injuries, damages, or actions arising due to injury to participants person or property
arising out of or in connection with the use by participant of the services, facilities, and
premises of the Club. Participant hereby holds the Club its officers, owners, agents and
employees harmless from all claims which may be brought against them by participant or
on participant’s behalf for any such injuries or claims.

Participant agrees to follows club rules. Violation of these rules may be the cause for
supspension or cancellation of class participation

PARTICIPANT’S SIGNATURE:__________________________________
if at least 18 yrs old or Parent of Guardian

NAME OF PARENT OR GUARDIAN:_____________________________
                           please print

				
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posted:11/18/2010
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