Waiver of Liability
I hereby waive liability and agree to indemnify and hold harmless Rice Lake Olympic Fitness Center, Blue Hills Tae Kwon Do, Eric Swan, their staff and instructors, whether paid or volunteer, for injuries, claims, or damages to me in connection with the Tae Kwon Do program, including classes, workouts, tournaments, or any other related activities. I understand that Tae Kwon Do is a physical contact sport and that injuries may occur. It is recommended that each student enrolling in this program consult his/her physician with respect to any past or present illness or injury that may affect his/her participation.
Signature _______________________________ Date ____________
Signature of parent or guardian ______________________________
(if student is under age 18)
Student name ____________________________________________
Address ________________________________________________
City _____________________________ Zip Code _______________
Date of Birth ____________________ Phone ___________________
Person to contact in case of emergency _______________________
Relationship ____________________ Phone ___________________
Emergency Hospital _______________________________________
Personal Physician ________________________________________
Any medical conditions that instructor(s) should be aware of: _______
________________________________________________________________________________________________________________
(Instructor reserves the right to refuse training to anyone.)
