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    Screaming Eagles Documents
    This document contains a student enrollment form for Screaming Eagles Martial Arts. It requests personal information about the student such as name, date of birth, contact information for parents/guardians, emergency contacts, and authorized pickups. It also includes a participation release waiving liability for injuries and allowing media use of photos/interviews, as well as contact information for the martial arts school.

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    Registration

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    Screaming Eagles Documents
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    This document contains a student enrollment form for Screaming Eagles Martial Arts. It requests personal information about the student such as name, date of birth, contact information for parents/guardians, emergency contacts, and authorized pickups. It also includes a participation release waiving liability for injuries and allowing media use of photos/interviews, as well as contact information for the martial arts school.

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    Screaming Eagles Martial Arts Registration Form

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    This document contains a student enrollment form for Screaming Eagles Martial Arts. It requests personal information about the student such as name, date of birth, contact information for parents/guardians, emergency contacts, and authorized pickups. It also includes a participation release waiving liability for injuries and allowing media use of photos/interviews, as well as contact information for the martial arts school.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    194 views2 pages

    Registration

    Uploaded by

    Screaming Eagles Documents
    This document contains a student enrollment form for Screaming Eagles Martial Arts. It requests personal information about the student such as name, date of birth, contact information for parents/guardians, emergency contacts, and authorized pickups. It also includes a participation release waiving liability for injuries and allowing media use of photos/interviews, as well as contact information for the martial arts school.

    Copyright:

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    Student Name: ________________________ Date of Birth: _________________ Age: ______ Parent/Legal Guardian Name: ____________________________________________________ Address: _____________________________City: ______________Zip

    Code: _____________ Home #: __________________Cell #: _________________Work #: _____________________ Email: _______________________________________________________________________ Emergency contact name and telephone#: ___________________________________________ Persons authorized to pick up your children, include relationship & phone number: 1. 2. _________________________________________________ phone#: ________________ _________________________________________________ phone#: ________________

    Additional Information:_________________________________________________________ Office entry only: Class Time: ____________________________ Days: ________________________________ Height: ______________ Weight: ______________ Uniform size: ____________________

    SCREAMING EAGLES MARTIAL ARTS www.screamingeaglesmartialarts.weebly.com 100 Executive Center Blvd., El Paso, Texas 79902 (915) 820-0739 screamingeagles.martialarts@yahoo.com

    PARTICIPATION RELEASE We the undersigned parents of _______________________________ permit the above named student to participate in the programs, events, demonstrations and camps offered by Screaming Eagles Martial Arts. In and for consideration of the granting of permission for said student to participate in this program and of the benefits to be derived, therefore we hereby assume full responsibility for said students personal safety and release Screaming Eagles Martial Arts, Eric Smith and instructors who will be participating in the program from all liabilities that may occur by reason of any injury to said student that may arise. Therefore, we agree to hold Screaming Eagles Martial Arts, Eric Smith and instructors harmless from all claims that may arise from any injury that may occur to said student by reason of said students participation, and the risks involved in respect to such a program are fully understood. I understand that this Waiver and Release form is binding as to my family members, heirs and executors. In case of a medical emergency, accident or illness, Screaming Eagles Martial Arts has my permission to secure medical attention as deemed necessary. I understand that I am responsible for any expenses associated with such treatment. I understand that every effort will be made to contact me or the person designated by me as soon as possible after such an occurrence. I acknowledge that I will read and become familiar with the program information, and I agree to abide by the terms and requirements described therein. I further agree that if I do not understand any portion of the material, I will ask for further clarification. Release for Media and Promotional Photographs / Interviews I give permission for myself, my son/daughter to be photographed or interviewed by the local media and also to take promotional pictures of my child or myself during Screaming Eagles Martial Arts activities and presentations and use them for advertising purposes. I have read and agree with the above:

    Print Full Name: _____________________________ Parent/Legal Guardian

    Signature: _________________________________ Parent/Legal Guardian

    SCREAMING EAGLES MARTIAL ARTS www.screamingeaglesmartialarts.weebly.com 100 Executive Center Blvd., El Paso, Texas 79902, (915) 820-0739 screamingeagles.martialarts@yahoo.com
    Screaming Eagles Martial Arts Insurance Carrier:

    915-778-5463

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