Event Waiver

Event Waiver
Friend of....Birthday Party - Birthday Child's Name
Your Child's NameFirst & Last Name
Home Phone Number
Postal Code:
Mom's NameFirst & Last Name
Dad's NameFirst & Last Name
Mom's Cell:
Dad's Cell:
Emergency contact number during the Event:
Medical Alert:
If Yes, please specify
Waiver: We the undersigned, hereby voluntarily submit our invitation to participate at the East West Karate Event and do hereby waive any and all rights, claims or action that we, our heirs, successors or assigns may have against Christina Magliocco, East West Karate, or any agents, employees of the event, for damages or any form of recovery from liability resulting from injuries that may incur as a result from our participation and or attendance at said event. We further agree to indemnify any and all of the above parties in any action based on our attendance and or participation at the East West Karate Event. We have read, understand and agree to abide by the rules associated with this event and assume all responsibility and any associated liability for the infringement of such rules. Additionally, we are fully aware of our personal medical condition and hereby certify that we are mentally and physically fit to participate in the said event. Any pictures taken may be used for promotional purposes without financial compensation.
I/We Accept the Waiver:
Parent/Guardian Name
Parent/Guardian Name:while participating at the Event
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