1. I hereby accept and understand that I am giving permission for myself/my child to partake in activities that presents certain risks.
2. I understand that it is my responsibility to ensure my physical fitness and health prior to participating in these activities.
3. I certify that I am physically fit to the best of my knowledge to partake in these potentially harmful activities.
4. I knowingly, voluntarily and expressively waive any claim that I may have against Affinity Dojo's, it's instructors and staff, and it's owners, for any injury, death or damages that I may sustain as a result of participating in a class, workshop, seminar held by Affinity Dojo's.
5. I release and discharge Affinity Dojo's, it's owners, staff and it's instructors from any liability, claim or action that may be related to the loss , theft or damage of personal property while participating in a class, workshop or seminar held by Affinity Dojo's.

I have read and fully understand the contents of the waiver above. I am 18 years or older or the legal guardian of persons under 18 years of age and voluntarily agree to the condition and terms.

Do you have any conditions the instructors should be aware of?
1. Asthma? 2. Heart conditions of any kind? 3.Dizzy spells?
4. Pregnancy 5. High or low blood pressure? 6. Diabetes?
7. Neck/back/spine injury? Joint pain or injury? i.e. knee/ankle/wrist/elbow/shoulder? 8. Disability?

Please specify (using the number of condition above and child's name) below and explain.

Child 1 Name:
DOB:

Child 2 Name:
DOB:

Child 3 Name:
DOB: