EmailMe Form - Rankin Martial Arts Application Release Form

Student(s) is/are Under NO obligation when completing this application!
The undersigned, who is enrolling as a student, minimum age 10 years old at Rankin Martial Arts LLC adult class located at 2 Postwood Drive, Palm Coast, FL 32164 and/or is a member of the class described below.

Hereby release Dr. William A. Rankin, PhD., Instructors, from liability for all injuries to person, loss, or damage to property, and claims in case of death or himself/herself incurred between the commencement and the conclusion of classes.

The understanding shall apply to all injuries, losses, damage, or death whether of a tangible or intangible nature, incurred during the tour described, irrespective of location or country in which the injury, loss, damage, or death occurred, whether on land or on water, or in the air, and whether in travel.

It is understood that this release shall be treated as a legal part of the consideration to Dr. William A. Rankin, PhD. provider, or the acceptance of the undersigned as a member of the class. We do not accept any contracts.

Name of 1st Applicant *

First MI Last

Date of Birth of 1st Applicant *

MM / DD / YYYY

Name of 2nd Applicant

First MI Last

Date of Birth of 2nd Applicant

MM / DD / YYYY

Any Martial Arts Training?

If Previous Training, What Style

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone *

### - ### - ####

Tuition per person *

Does Studen Have any Health Issues? If yes, please explain to instructor during the interview meeting. *

Yes

No

By signing this document, you understand the information given is true. Any false information is grounds for immediate dismissial! *

Yes

No

Print Parent's Full Name *

First MI Last

Signature of Parent or Legal Guardian if under 18 years of age, will be done in front of the instructor