Girl Scout Self Defense Class Permission Slip

Please complete prior to our Training on March 18th!!

• Participant's First Name

  Participant's Last Name
  

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  Make Required
• Birthday
  

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  Make Required
• 2nd Participant First Name

  2nd Participant Last Name
  2nd Participant Birthday
  Add Another Participant
  
• Mom's First Name

  Mom's Last Name
  

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  Make Required
• Dad's First Name

  Dad's Last Name
  

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  Make Required
• Email Address

  

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  Make Required
• Mobile Phone
  

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  Make Required
• Does your child have any medical concerns that we should be aware of?
  

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  Make Required

• I agree

  In consideration for my, my child's, attendance and participation in the martial arts training offered by Success Martial Arts. I, the parent, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Success Martial Arts, it's management, assigned staff, guest instructors and fellow students from any liability resulting from loss, whether personal belongings or bodily injury. I also hereby state, that my child is physically fit to take the prescribed course of instruction and do so of my own free will in exchange for an agreed upon fee. 

  

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