
Brighton - 3450 Winton Place, Rochester, NY
Penfield - 2160 Penfield rd., Penfield, NY
Webster - Bay Towne Plaza, Webster, NY
Matt Dorsey
mdorsey@rochesterkarate.com;
(585) 475-9250
3450 Winton Place
Rochester, NY 14623
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July 10 - 13 - Penfield branch
July 17 - 20 - Webster branch
July 24 - 27 - Brighton branch
I understand that the study of Karate, jiujitsu and other martial arts requires physical contact in many contexts including, but notlimited to, sparring, hand-to-hand combat and self-defense techniques and alsoacknowledge that injury is an inherent potential result of any suchactivity. I also represent that I ammedically and physically able to participate in the exercises and physicaldemands of the discipline. I also agree thatany injuries or limitations will be made known immediately. I also understand that there is no guaranteefor my personal safety after the completion of this course. In view of the foregoing and as a term andcondition of being a student of Martial Arts America, I, with the intention of bindingmyself, my spouse, heirs, legal representatives, and assigns, expressly releaseand discharge Martial Arts America, their owners, employees and legalrepresentatives from all claims, demands, actions, judgments and executionsthat I ever had, or now have or may have or that anyone claiming through himmay have or claim to have, against Martial Arts America, their owners,employees or legal representatives created by or arising out of any and allclass activity regardless of where held or when held. Also, I agree to allow,without compensation, the unrestricted use of any photographs, films orvideotapes of myself. In witness whereof, I execute this release on this dayand year written below.
I hereby give my permission to the medical personnel selected by the Day Camp Coordinator to order x-rays, routine tests, treatments, and necessary transportation for the child named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the Day Camp Coordinator to secure and administer treatment, including hospitalization, for the child named above.