Best Martial Arts Institute

Registration Form for Adults

 

 

 

I am enrolling in the following program(s): 

 

Student's Full Name    Age    Date of Birth  

Email     Phone #  

Address 

City    State  ZIP

Upload a head shot in the style of a Passport Photo. This will only be used by our office staff to help with name recognition. It does NOT need to be a professional photo. A selfie will work!

(Allowed file extensions are jpg, jpeg, jpe, gif, png, pdf)

 

Place of Employment   Occupation Work #

List any allergies or medical problems:

List any prescription medications:

Have you ever been convicted of a felony or violent crime?

If yes, explain:  

 

Spouse/Partner's Information

Name  Email   

Phone #   Work #

 

Additional Emergency Contacts: 

Name  Relationship  Phone #

Name  Relationship  Phone #

 

How did you hear about us?

Referred by a friend?  Let us know their name, so we can thank them.

Other

 

 

Please list any previous martial arts experience:

From To  School Name  Style 

City, State  Instructor Rank Received

 

From To School Name Style  

City, State Instructor Rank Received  

 

Instruction Agreement

THIS AGREEMENT is made and entered into by and between , (hereinafter referred to as Student), and Alan Best, representing Best Martial Arts Institute (hereinafter referred to as Instructor).

IN CONSIDERATION for membership of Student in Best Martial Arts Institute, Student agrees to pay to Instructor a membership fee on the first of each month commencing . Membership of Student will continue until such time as Student cancels membership. Written notice of cancellation of membership must be given to Instructor by the 15th day of the month prior to cancellation of membership.

Student is enrolling in the following program/s

The current monthly membership fee is  

The parties further acknowledge, agree, and understand as follows:

  1. That Student will be responsible for the payment of monthly dues on the first of each month until written notice of cancellation of membership is given;
  2. That a late fee of $10 will be charged to Student if payment is not received by the 10th day of the month due;
  3. That Student shall be permitted to participate in class only after payment has been made for the month due;
  4. That instruction shall be provided in martial arts, with the scope of instruction to be determined by Instructor and his staff;
  5. That instruction shall be provided not only by Instructor, but also by his staff and such high-ranking students as may from time to time be designated;
  6. That instruction will generally be provided to Student as a member of a class composed of individuals of varying ages and ranks;
  7. That any and all personal equipment to be worn or used by Student shall be provided at the expense of Student;
  8. That the teaching of discipline, both physical and mental, is an integral part of martial arts instruction and advancement; that, in this regard, Student authorizes Instructor and his staff to require obedience within the dojo and to administer such discipline as is deemed necessary for proper development of Student;
  9. That progress of Student depends largely on personal dedication and regular attendance, and that Student shall notify Instructor prior to the absence of Student from any regular training session;
  10. That testing for advancement will be made available to Student upon the recommendation of Instructor, but that promotion is not assured or guaranteed by Instructor;
  11. That payment of a promotion examination fee shall be required of Student before administration of any promotion test, but that payment of such fee shall not serve to guarantee either promotion to or proficiency at a particular level;
  12. That promotion tests will be conducted by Instructor and/or such members of his staff as he may designate;
  13. That Student shall not participate in any class, seminar, camp, exhibition, tournament, or other organized martial arts activity outside Best Martial Arts Institute without the express consent of Instructor;
  14. That Student shall not teach any martial arts skills learned at Best Martial Arts Institute without permission from Instructor;
  15. That Instructor advises Student to consult a physician before Student engages in martial arts training;
  16. That Student hereby assumes all risk of personal injury or illness that may be incurred by Student while attending, traveling to or from, and/or participating in Best Martial Arts Institute activities; that Student, acting alone or for heirs, personal representatives, and assigns, does hereby release Instructor, property owner, manager, landlord, host, sponsor, officers, agents, and employees of Best Martial Arts Institute from all liability including claims and suits at law or equity from any injury or illness whether permanent, fatal, or otherwise, that may result, directly or indirectly, from traveling to, participating in, or returning from said activities;
  17. That Student hereby assumes all risk of loss or damage to personal property of Student that may be brought to or left in Best Martial Arts Institute; that Student, acting alone or for heirs, personal representatives, and assigns, does hereby release Instructor, property owner, manager, landlord, host, sponsor, officers, agents, and employees of Best Martial Arts Institute from all liability, including claims or suits at law or equity that may result from damage of theft of property of  Student while such property is at Best Martial Arts Institute;
  18. That Student shall indemnify and hold Instructor harmless from all claims, actions, suits, liability, loss, expense, or damage of every kind and description, including investigation costs, court costs, and attorney fees, that may accrue to or be suffered or claimed by any person or persons, arising from unsupervised and unauthorized use by Student of those martial arts skills learned through association with Best Martial Arts Institute; and
  19. That Instructor retains the right to terminate instruction of Student if Student fails to abide by the terms of this agreement, the rules of Best Martial Arts Institute, or if Instructor considers the attitude of Student to be unsuitable to continue in or be associated with Best Martial Arts Institute; that, in such an instance only, the remainder of any money paid by Parent for the contract period in which termination occurs shall be refunded on a percentage basis, determined by the time remaining in the period. 

 

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Signature Certificate
Document name: BMAI Registration form - Adults
lock iconUnique Document ID: fe89ee72db5a47b9f0fb2f6cee069263af6435ba
TimestampAudit
March 7, 2022 10:14 pm PSTBMAI Registration form - Adults Uploaded by Alan Best - Bestmartialartsinstitute@gmail.com IP 24.21.120.146