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 voluntarity submit our invitation to pafticipate 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 pafticipation and or attendance at said event. We further agree to indemnify any and all of the above pafties 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 assocrated with this event and assume all responsibility and any associated liability for infingement of such rules. Additionally we are futty aware of our personal medical condition and hiereby ceftify that we are mentally and physically fit to participate at 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

About Us


Martial Arts in the Mississauga, Brampton, Oakville Area.

East West Karate & Fitness specializes in helping people develop a healthy mind and body, and to feel more secure through quality, comprehensive, and professional karate instruction. Whether your goal is self-defense, greater confidence, physical conditioning, stress reduction, flexibility, coordination or sport, East West Karate & Fitness is the POWERFUL ALTERNATIVE that will get you the results you are seeking.

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Contact Info


East West Karate & Fitness
Phone:    (905) 891-9448
Email:     gojueastwest@hotmail.com
Address: 1107 Lorne Park Road #9, Mississauga, Ontario L5H 3A1

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