Personal Information:
Emergency Contact Name & Phone
Do you have any other prior Martial Arts or Combat Sports experience? *
Do you have any criminal history? *
Medical conditions or injuries we should be aware of? *
Medicare or Insurance Number (Optional):
I, the undersigned, understand that participation in martial arts and combat sports involves physical risk.*
I agree to release and hold harmless Ki-Shin Jiu-Jitsu, its instructors, Nathan Leonard Richards, and any staff or affiliates from any liability for injuries or damages arising from participation, training, or events. *
I confirm that I am physically fit and capable of participation, and I assume all risks involved. *
I understand that it is my responsibility to inform instructors of any injuries or conditions that may affect my training.*
I agree there are risks to any martial arts training and I hereby agree to take on all risk and liability and indemnify all other parties listed from any damages or injuries that may arise from martial arts training with Nathan Leonard Richards.*