Karate Release Student ProfileName* First Last DOB* Sex*MaleFemalePrefer To Not DisclosePrevious TrainingLearning Objectives Physical Fitness Increased Flexibility Improved Focus, Grades & Productivity Interested in Family Activity Development or Inner Direction, Leadership Skills Stress Management Improved Self Esteem Self Defense Channeling of Energies Interested in Competition Experience General Interest in Martial Arts Interested in Long Range Developement Want an Environment of Traditional Values in which to Learn Please select all that apply.Parent or Guardian InformationName* First Last Phone*Email* Address* Street Address City State ZIP Safety Affirmation and ReleaseI hereby certify that I am aware of, and understand, all of the risks and dangers inherent in participating in martial arts. I hereby promise not to bring a claim agains or sue Pure 8 Yoga, LLC (d/b/a Pure 8 Hot Yoga Studio), its officers, instructors, employees, agents, members or authorized guests. I freely and voluntarily accept all risks of injury, death, or property damage and agree for myself and heirs to RELEASE, HOLD HARMLESS AND INDEMNIFY Pure 8 Yoga, LLC (d/b/a Pure 8 Hot Yoga Studio), its officers, instructors, employees, agents, members or authorized guests from any and all liability for personal injury, including death, and property damage resulting from Pure 8 Yoga's negligence or otherwise, including but not limited to personal injury caused by Pure 8 Yoga's operation of the karate academy, the conditions of the premises, or from my or my child's participation in any recreational activities at, or sponsored by, the karate academy. I assume full responsibility for maintaining my or my child's physical fitness at a level appropriate to participate in martial arts. I understand that I or my child should have had a physical examination to assure of fitness level, and understand that Pure 8 Yoga (d/b/a Pure 8 Hot Yoga Studio) does not assume and responsibility for my or my child's physical fitness. I herby certify that I have had sufficient time and opportunity to read and review this RELEASE. I further hereby certify that I am of legal age or a legal guardian of student and am competent to sign this RELEASE. I understand that the terms of the RELEASE are legally binding and not a mere recital. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS AFFIRMATION AND RELEASE BY READING IT BEFORE I SIGNED IT.Parent or Guardian Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.