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BIRTHDAY PARTY WAIVER

Parent First Name

Parent Last Name

Cell Phone

Location

Whose party are you attending?

I represent that I am/my child is physically fit to receive instruction and participate in this program and I understand and agree that Kicks Karate, or its owners, will not be held liable for any injuries, damages, etc. not caused by or resulting from the negligence of the owners, operators or persons in charge of such establishment, and likewise assume full responsibility for all my actions in connection with this martial arts program.

Kicks Karate Inc. 12105 Darnestown Rd.Gaithersburg, MD 20878