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KAIJIN MMA                                                                                                                                Student Profile,
                                                                                                                                                Acknowledgement,
                                                                                                                                                          and Release

{_______________________________________}          {________________________________________}
Student Name                                                                     Date of Birth

{_____________________________________________________________________________________}
Parent Name(s) (If under 18)

{_____________________________________________________________________________________}
Address

{_______________________________________}           {________________________________________} Email                                                                                   Phone

{_____________________________________________________________________________________}
Emergency Contact and Phone

{________________________________________}         {_______________________________________}
Health Conditions/Injuries                                                   Previous Experience

   The Student understands and agrees that strict observation of Kaijin's rules and the rules relative to the service or instruction provided, including the use of protective equipment, is required. The Student understands and agrees that the use of Kaijin's facilities and the Student's presence at Kaijin's facility are at the sole risk of the Student.
   The Student understands and agrees that the services or instruction provided may involve skills and training which include violent and sudden movements and that in connection with the training, there will be physical contact between instructors and Students, and between and among Students, and that such contact may result in personal injury to the Student, despite precautions taken to avoid suck injuries. Student hereby consents to engage in such contact as may be necessary or required by Student's participation.
   The Student, on behalf of him'herself and anyone claiming by or through the Student, hereby holds harmless, releases and forever discharges Kaijin and its instructors and authorized representatives from any liability, claim, loss, including loss of property, damage, personal injury, or expense incurred by the Student and arising from the Student's execution of this Agreement, payment processing, participation in any program offered by Kaijin.
   The Student specificaly understands and agrees that he/she is assuming the risk of any and all injuries that he/she may suffer or incur as a result of his/her execution of this Agreement and participation in any program offered by Kaijin.
I HAVE READ THE ABOVE WARNING, WAIVER, RELEASE, AND AGREEMENT TO PARTICIPATE. I UNDERSTAND IT'S CONTENTS AND DO HEREBY SIGN IT VOLUNTARILY.

{_______________________________}     {________________________________}  {_________________}
Kaijin Representative                                    Student Signature (Parent, if under 18)       Date

Photo Release:
The Student (Parent, if under 18) gives consent to be photographed or recorded on video during instruction at Kaijin's facility, and for Kaijin to use the resulting images and/or recordings for promotional purposes of the facility including, but not limited to, Kaijin's website, social media sites (Facebook, Instagram, etc.), flyers and other physical promotional materials.

{_______________________________}     {________________________________}   {________________}
Kaijin Representative                                    Student Signature (Parent, if under 18)        Date