Student *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Student (2)

Second participating family member if applicable.

First Name

Last Name

Student (2) Date of Birth

MM

DD

YYYY

Uniform

Please indicate if you require a uniform. Uniform cost including crests is $75.

Yes

No

Parent/Guardian Name

If student(s) are under 18 years of age.

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Email Permission *

I provide my permission as defined by Canadian Anti-Spam Legislation for Nine Degrees to send me email regarding updates and information. I can unsubscribe at any time by contacting crestmonttaekwondo@gmail.com.

I am Fully Aware of and Accept *

All the risks and dangers involved in physical training and the participation in classes, tests, gradings, demonstrations, tournaments and competitions, particulars of which include but are not limited to: all manner of injury resulting from falling and impacting the ground or floor, being struck by the hands or feet of others, from the use of the hands, feet or other body parts in the breaking of boards or other objects, or from over exertion of muscles, bones, joints or other body parts as well as strains, sprains or breakage of said body parts.

Release and Waiver of Liability *

I release, save and hold harmless and indemnify Nine Degrees Consulting Inc., its instructors, agents, employees and students, from and against all claims, actions, costs and expenses and demands in respect to death, injury, loss or damage to my person or property/death, injury, loss or damage to the person or property of my child, or to any other person or property, whosesoever and howsoever caused, arising out of or in connection with my taking part in Tae Kwon Do classes, and attendance at the premises of Nine Degrees Consulting Inc. and notwithstanding that the same may have been caused, contributed to or occasioned by any act, failure or omission, including gross negligence, negligence or breach of any contractual, statutory, or common-law obligation, of Nine Degrees Consulting Inc., or any of its instructors, agents, employees and students.

Media Release *

I provide Nine Degrees the right to use without compensation the Student’s photograph whether action or still or their parts, montages or compositions in connection with advertising and promotion of Crestmont Tae Kwon-Do School whether by way of printed media, digital media or otherwise.