Pallen's Martial Arts Buddy Week Waiver 2023

Please complete this waiver/questionnaire in order for you or your child to participate. This waiver is to be completed by the parent of the Buddy NOT the parent of the Pallen student.

• This form is for buddies only and should be completed by the parent of the non-Pallen member who is attending as a Buddy.

  Important: Parent/guardians you must accompany your child to Pallen's and be present when they are taking class.

  

• Thank you for your interested in attending the Pallen's Martial Arts Buddy Day!  

  Your child has been invited to attend by a current Pallen's student, please complete this from prior to coming to the class.  

  Our staff can't wait to meet you all!

  Pallen's Martial Arts

  1660 Washington Avenue

  San Leandro, CA  94577

  
• Participant Buddy's First Name

  Participant Buddy's Last Name
  

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• 2nd Buddy's First Name

  2nd Buddy's Last Name
  2nd Buddy's Birthday
  Add Another Participant
  
• Buddy's Street Address
  Address Continued
  City

  State/Province
  Postal Code
  

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• Name of the school your child attends and the city it is located in.

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• Participant Buddy's Email Address

  

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• Buddy's Parent Mobile Phone
  

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• Buddy's Birthday
  

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• Buddy's Parent/Guardian's First Name

  Buddy's Parent/Guardian's Last Name
  

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• Please select the class that you will be attending. The class selection is according to age. If your child is between 4.5-6.5 years old, please select a TIGER class option. If your child is between 7-11 years old, please select a FRESHMEN class option. If your child is a teen/adult and over the age of 11.5 years olds, please select a TEEN/ADULT class option.

  TIGERS (4.5-6.5 yr olds): MONDAY JUNE 8 @ 4:00 pm - at our Fitness Center location: 1660 Washington Avenue TIGERS (4.5-6.5 yr olds): TUESDAY JUNE 9 @ 5:45 pm - at our Fitness Center location: 1660 Washington Avenue TIGERS (4.5-6.5 yr olds): WEDNESDAY JUNE 10 @ 4:00 pm - at our Fitness Center location: 1660 Washington Avenue TIGERS (4.5-6.5 yr olds): THURSDAY JUNE 11 @ 5:45 pm - at our Fitness Center location: 1660 Washington Avenue FRESHMEN (7-11 yr olds): MONDAY JUNE 8 @ 5:45 pm - at our HASP location: 1655 East 14th Street FRESHMEN (7-11 yr olds): MONDAY JUNE 8 @ 6:30 pm - at our Fitness Center location: 1660 Washington Avenue FRESHMEN (7-11 yr olds): TUESDAY JUNE 9 @ 4:00 pm - at our Fitness Center location: 1660 Washington Avenue FRESHMEN (7-11 yr olds): WEDNESDAY JUNE 10 @ 5:45 pm - at our HASP location: 1655 East 14th Street FRESHMEN (7-11 yr olds): WEDNESDAY JUNE 10 @ 6:30 pm - at our Fitness Center location: 1660 Washington Avenue FRESHMEN (7-11 yr olds): THURSDAY JUNE 11 @ 4:00 pm - at our Fitness Center location: 1660 Washington AvenueTEEN/ADULT (11.5 years +): MONDAY JUNE 8 @ 7:15 pm - class at our Fitness Center location: 1660 Washington AvenueTEEN/ADULT (11.5 years +): TUESDAY JUNE 9 @ 7:15 pm - class option at our HASP location: 1655 East 14th Street TEEN/ADULT (11.5 years +): WEDNESDAY JUNE 10 @ 7:15 pm - class at our Fitness Center location: 1660 Washington AvenueTEEN/ADULT (11.5 years +): THURSDAY JUNE 11 @ 7:15 pm - class option at our HASP location: 1655 East 14th Street
  

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• Who invited you to Buddy Day? Name of your friend who attends Pallen's Martial Arts (first and last)

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• What struggles do you have with your child?
  

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• What else have you tried? I.e. sports, activities, etc... And what has interested you the most?
  

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

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• Type of Student:

  Honor RollAverageNeeds a little help
  

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• Please check the benefits most important to you.

  Self-Confidence

  Self Esteem

  Respect

  Improved Behavior

  Physical Fitness

  Weight Control

  Strength & Flexibility

  Coordination

  Focus

  Self-Discipline

  Concentration

  Self-Control

  Burn Energy

  Leadership

  Fun!

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  Self-Confidence,Self Esteem,Respect,Improved Behavior,Physical Fitness,Weight Control,Strength & Flexibility,Coordination,Focus,Self-Discipline,Concentration,Self-Control,Burn Energy,Leadership,Fun!

• I agree

  In consideration for my child's attendance and participation in the martial arts training offered by Pallen's Martial Arts. I, the student/parent, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve the school, it's management, assigned staff and fellow students from any liability resulting from loss, whether personal belongings or bodily injury. I also hereby state, that myself or 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. I understand there is a no refund policy on any monies I will pay Pallen's Martial Arts.

  

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