Parents Night Out

Alpha Martial Arts

Parents First Name *

Parents Last Name *

Phone *

Email *

Student Name *

Emergency Contact 1 Name *

Emergency Contact 1 Phone *

Emergency Contact 1 Relation *

PLEASE LIST ANY INFORMATION THAT YOU, AS A PARENT, THINK WE SHOULD KNOW HERE. *

PLEASE LIST ANY MEDICAL CONCERNS/ALLERGIES HERE: PLEASE NOTE IF MEDICATION IS REQUIRED TO BE TAKEN AT THE DOJO, WE WILL NEED YOU TO FILL OUT A MEDICATION RELEASE FORM AND GIVE US THE PRESCRIBED MEDICATION. *

I UNDERSTAND THAT ALPHA MARTIAL ARTS IS A MARTIAL ARTS SCHOOL AND NOT A DAYCARE IN AS SUCH, THEIR STOCK IN TRADE IS NOT SUPERVISION AND CARE. THEIR INTENT IS TO TEACH MARTIAL ARTS ; PHYSICAL AND DROP -IN FACILITY AND THAT AS SUCH, MY CHILD(REN) IS/ARE FREE TO COME AND GO AND IF MY CHILD(REN) IS/ARE TO STAY AT THE FACILITY, IT IS BECAUSE OF MY DIRECTION. *

I AGREE

I authorize that I am the parent/legal guardian of the child (ren) named below. I give my child(ren) permission to participate in the Alpha/Parrish's BEST Parent's Night Out Event. I understand and agree to hold harmless and covenant not to sue Alpha Martial Arts Academy, it's owners, directors, managers, employees, or volunteers, for any injury or loss that may occur to my child (ren) as a result of participating in this PNO. I understand that my child(ren) will be participating in physical activities such as, but not limited to: martial arts, dodgeball, fitness exercises, running, jumping, etc. I give my permission for Alpha/Parrish's BEST to use images and video from this event for promotional purposes. I agree to pick up my child(ren) no later than the advertised end time or I will be charged $1 per minute that I am late. *

I authorize that I am the parent/legal guardian of the child (ren) named below. I give my child(ren) permission to participate in the Alpha/Parrish's BEST Parent's Night Out Event. I understand and agree to hold harmless and covenant not to sue Alpha Martial Arts Academy, it's owners, directors, managers, employees, or volunteers, for any injury or loss that may occur to my child (ren) as a result of participating in this PNO. I understand that my child(ren) will be participating in physical activities such as, but not limited to: martial arts, dodgeball, fitness exercises, running, jumping, etc. I give my permission for Alpha/Parrish's BEST to use images and video from this event for promotional purposes. I agree to pick up my child(ren) no later than the advertised end time or I will be charged $1 per minute that I am late.

I have read and agree to the liability statement above *

I agree.

Sell Products *

PARENTS NIGHT OUT

$50

Signature *

Clear