Trial Class Waiver

Waiver for Free Trial Class

Please contact us to schedule your free trial class before completing this form.

* Indicates required field

Student Name *

Student Birth Date *

Name of Parent/Guardian (if applicable) *

Email *

Phone Number *

Class Placement for Student *

Student is dominant with *

Right hand Left hand Fairly equal

Scheduled date & time for trial class *

I/we agree to the following:
I/we will follow the studio's photography guidelines. No flash. Shutter sound off. Take photos discreetly so the students and instructor are not distracted by it. Photos and videos taken only of your child in action.
I/we will not talk/signal to students during class.
I/we will wear shoes in the bathroom.
I/we will keep shoes off the training mats.
I/we will keep our voices down, will mute sound on electronics, and take phone calls outside.

Student or Parent/Guardian Signature *

As the student and/or the parent/guardian of the student listed above, I understand that martial arts is a physical activity in which accidents and injuries may occur, and I agree not to hold Justin Press, Ephrata Martial Arts, and/or its teachers or associates responsible for any loss, injury, accident, or liability that might occur while I or my child are participating in classes, competitions, etc. I further state that all students listed are in good health and are not restricted from any physical activities such as martial arts, etc

Student or Parent/Guardian Signature *

Submit