Release Form Liability Waiver PhoneThis field is for validation purposes and should be left unchanged.Event Type(Required)Type of EventTrial ClassBirthday PartyValentine's PartyHalloween PartyName First Last Name(Required) First Last Email(Required) Phone(Required)Participant's Date of Birth(Required) Month Day Year Address(Required) Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent(Required)The undersigned hereby acknowledges the existence of certain risks in this type of training and agrees to assume all risks and responsibility. He/she further relieves The Martial Arts Center, Inc., Michael Hernandez, assigned instructors, and any other person or persons acting on their behalf, of all liability resulting from personal injury or loss of personal property. The undersigned further stipulates that he/she is physically sound and that he/she has medical approval to proceed with this type of training & will provide their own health/ accident insurance. The undersigned agrees that this release shall remain in force indefinitely from the date above. I agree to the above liability statement. Contact Information Our Address 2002 Weems Rd.Tucker, Georgia 30084 Call Us (404) 315-1040 Open Hours Monday – Thursday: 3PM – 9PMSaturday: 9AM – 12PM
