I, the undersigned, do hereby voluntarily submit my application for acceptance, attendance and instruction at United Karate - Ft Oglethorpe.

I understand that I have enrolled in a self-defense class. This class is for those ages 12 and up. I do hereby assume full responsibility for any and all damages, injuries or losses, I may sustain or incur, if any, while attending or participating and hereby waive any and all claims against United Karate - Ft Oglethorpe, Derrick and Carly Pendergrass as well as any and all staff members, instructors and assistant instructors, individually, in full or otherwise for any claim of injuries that I may sustain. 

I also state that I have no medical problems including but not limited to heart conditions, epilepsy, hernias, etc. I fully understand that any medical treatment given to me will be of First Aid type only, and I fully waive all claims for injuries or damages which may result from such treatment, whether given with or without expressed consent.

I consent that any photographs or video recordings furnished by me or taken of me in connection with United Karate - Ft Oglethorpe can be used for any publicity, promotion, or television showing, and I waive any compensation in regards thereto.

I have read and fully understand the statements in the preceding waiver and acknowledge the complete acceptance of same.