Centreline Kung Fu Hall

Registration Form

Please fill in the form below. Fields with red asterisk are mandatory entries.
Full Name of Student *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *
E-mail
Date of Birth *

Month Day Year
Date Date Picker Icon
Do you have any physical ailments, injuries, impairments, learning disabilities that we should know about?
I acknowledge that *

monthly fees are to be remitted on the first class of every month.
I acknowledge that *

a uniform should be purchased within one month of registration or when available. In the meantime, the dress code is all black attire.
Emergency Contact Information
Name of Emergency Contact

First Name Last Name
Phone Number
Relationship to Student

General Information

All questions on this page are optional.
What other sports, recreations, physical activities, or hobbies do you participate in now?
What benefits are you seeking from this class?
How did you hear about us?
Do you have any comments or questions you would like addressed?

Release of Liability

ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY
For Participants Over the Age of Majority in the Province or Territory in which the Athletic Activities are Provided by the Organization

WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS.
READ IT CAREFULLY!

Every Person Read and Understand this Waiver Before Participating in Athletic Activities.

The following waiver of all claims, release from all liability, assumption of all risks, and other terms of this agreement are entered into by me (the “Participant) with and for the benefit of: their directors, officers, employees, volunteers, business operators, agents and site property owners or Occupiers (the “Organization”). Occupiers is defined in accordance with the definition of Occupiers contained in the Occupiers Liability legislation applicable to the Province or Territory in which the Athletic Activities are provided by the Organization.

Please Check Each item below after Reading and Understanding each item:

“Athletic Activities” include but are not limited to contact and non-contact sports, fitness activities, personal training instruction and activities, use of facilities, and fitness programs and services provided to the Participant by the Organization.
*

1. I am aware that there are inherent and significant risks (“Risks”) associated with the participation in Athletic Activities. I am aware that those Risks include, but are not limited to, the potential for serious personal injury caused by any event or any condition of the facility or equipment where Athletic Activities are provided by the Organization, and health risks such as transient lightheadedness, fainting, abnormal blood pressure, chest discomfort, muscle cramps or soreness, and nausea. I understand the Risks are relative to my own state of fitness and health (physical, mental and emotional), and to the awareness,care and skill with which I conduct myself while participating in Athletic Activities.
*

2. I freely accept and fully assume all responsibility for all Risks and possibilities of personal injury, death,property damage or loss resulting from my participation in Athletic Activities. I agree that although the Organization has taken steps to reduce the Risks and increase safety of the Athletic Activities, it is not possible for the Organization to make the Athletic Activities completely safe. I accept these Risks and agree to the terms of the waiver, even if the Organization is found to be negligent or in breach of any duty of care or any obligation to me in my participation in Athletic Activities.
*

3. I acknowledge my obligation to immediately inform the nearest employee of the Organization if I feelany pain, discomfort, fatigue or other symptoms that I may suffer during and immediately after myparticipation in Athletic Activities. I understand I may stop participation at any time, and I may berequested to stop by an employee or volunteer of the Organization who observes any symptoms ofdistress or abnormal response.
*

4. I confirm that I have reached the age of majority in the province or territory in which I am participatingin Athletic Activities.
*

5. In addition to consideration given to the Organization for my participation in Athletic Activities, I and my heirs, next of kin, executors, administrators and assigns (collectively my “Legal Representatives”) agree:
a. To waive all claims that I have or may have in the future against the Organization; to release and forever discharge the Organization from all liability for all personal injury, death, property damage, or loss resulting from my participation in the Fitness Activities due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error of judgment of the Organization; and

b. To be liable for and to hold harmless and indemnify the Organization from all actions, proceedings,claims, damages, costs demands including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with my participation in Athletic Activities.

c. I agree that this waiver and all terms contained within are governed exclusively by the laws of the Province or Territory of Canada in which the Athletics Activities are provided to me by the Organization. I hereby irrevocably submit to the exclusive jurisdiction of the courts of that Province or Territory. Any litigation to enforce this waiver must be instituted in the Province or Territory in which the Athletic Activities are provided by the Organization.
*

6. I confirm that I have had sufficient time to read and understand each term in this waiver in its entirety, and have agreed to the terms freely and voluntarily. I understand that this waiver is binding on me and my Legal Representatives.
Student Signature *

Clear

Payment Processing. (Can be done below or in-person.)

Intro Program (Adult) $ 45.00 CAD

Total $ 0.00 CAD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

Registration Form

Emergency Contact Information

General Information

Release of Liability