Smith Fitness & Martial Arts - Waiver

Date: Name: Phone Number:
Email: Age: Birthday:
Program Name: Parents Name: Address:

In consideration for my participation in Smith Martial Arts & Fitness (SMA / Smith Martial Arts LLC) training events, I acknowledge the existence of certain inherent risks in cardiovascular exercise, weight training, and or body building, this type of training and agree to assume all risks of injury, including but not limited to death of the participant arising from this event and or participants neg . I relieve SMA / Smith Martial Arts LLC., its Management, Staff, and fellow students, from any liability resulting from injury or loss of belongings. The students named above are physically fit to take the prescribed course of instruction and do so of their own free will and prior health or injury.

I grant Smith Martial Arts LLC, the irrevocable right to use my name (or nickname) , videos, or picture in all forms and media in all manners, for advertising or other lawful purposes, and I waive the right to approve the finished version, including written copy that might be created in connection therewith.

Signature: Date:
Parents Name: Date:

Parent signature if participant is under 18 years of age 100 SE Bridgeford Blvd. Smithma.com 541-862-1520