Note: ALL information will be kept in the strictest of confidence. This information is being collected for reasons of safety and for contact purposes only. In the event of an emergency this information sheet can be given to the attending paramedics. It is the responsibility of the student (Parent/Legal Guardian) to keep this information up-to-date. Pleases return this sheet completed and signed.

Thank You

Head Instructor
Victor Cooke.
Master 5th degree Black Belt

Participant Waiver, Release and Indemnity Agreement

Release, Waiver and Indemnity: In consideration of the acceptance of my application and the permission to participate as a student in Tae Kwon Do classes as taught by Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA. I Agree to abide by all the rules of Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA. I further agree that I will not hold Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA or any instructor or member of Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA., or facility were instruction is given responsible for any injury that I might sustain as a result of my participation in the Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA program. I for myself , my heirs, executors, administrators and successors, release all and any claims against Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA., and any instructor of Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA classes, and facility where Cooke’s Tae Kwon Do / Cooke's Martial Arts /CMA instruction is offered, arising out of personal injuries sustained while participating in the program and while on the premises on which the program is presented, and all other successors and assigns of and from all claims, demands, damage costs, expenses, actions and causes of actions whether in law or equity, in respect of death, injury, loss whether as a spectator, participant, competitor or otherwise, whether prior to, during or subsequent to the program and notwithstanding that the same may have been contributed to or occasioned by the negligence of any of the aforesaid. I further hereby undertake to hold and save harmless and agree to idemnify all of the aforesaid from said program. By submitting this application, I acknowledge I have read, understood and agree to the above waiver, release and indeminity. Participation in any of these activities/programs should be considered a high risk sports activity/program, my participation in any of these activities/programs is at my own risk, and further I warrant that I am physically fit to participate in these activities/programs.

Photo Release
The purpose of this is to give permission for the use of names and photographs of students of Cooke’s Tae Kwon Do/ Cooke’s Martial Arts Club for the use in newspaper articles, brochures, promotional materials , Website , and as well as promotional displays set up by Cooke’s Tae Kwon Do /Cooke’s Martial Arts /CMA .