• {first_name} - First name
• {name} - Full name
• {dob} - Date of birth
• {address} - Member address
• {phone} - Phone number
• {contact_name} - Emergency contact (if member has any)
• {contact_phone} - Emergency contact phone
• {contact_relation} - Emergency contact relation

It is fully understood by Participant or as Parent/Legal Guardian for their Minor Child/Participant, that:

a. There are risks and dangers associated with participation and training in karate and associated activities which could resulting bodily injury, partial and/or total disability, paralysis and death;

b. The social and economic loses and/or damages resulting from these risks and dangers could be severe;

c. These risks and dangers may be caused by the action, inaction, sole negligence, or partial negligence, of RMA, associated clubs, its owners, employees, class instructors, and agents; and

d. There may be other risks not known or reasonably foreseeable at this time. The undersigned Participant or as Parent/Legal Guardian for their Minor Child/Participant accepts and assumes such risk and responsibility for the losses and/or damages for any injury, disability paralysis or death, whether caused in whole or in part by the negligence of Rogers Martial Arts (hereinafter "RMA"), associated clubs, its owners, employees, class instructors, and agents.

This Release and Waiver of Liability includes premises conditions and premises activities resulting in an injury, property damage, or wrongful death which is caused in whole or in part by the negligence of RMA, associated clubs, its owners, employees, class instructors, and agents.

The undersigned Participant, or as Parent/Legal Guardian for their Minor Child/Participant, acknowledges reading this Release and Waiver of Liability, fully understands the terms, and has signed it freely and voluntarily without any inducement, assurance, or guarantee being made, and intend to be giving a complete and unconditional release of all liability to the greatest extend allowed by law by signing below.

• {sign_date} - Date document was signed (if applicable)
• - Name of the member or guardian signing the document (if applicable)