KINETIC KICK INC.
145 D WEST BANKHEAD STREET
NEW ALBANY, MS 38652
(662)322-4610
KINETIC KICK PROGRAM MEMBERSHIP AGREEMENT
Member Information
Please PRINT Using CAPITAL Letters
Student Name: _____________________________________________DOB____/_____/____
Address: _____________________Apt _____City ____________State_____Zip ___________
Billing Name : _________________________SS#________________Relationship ____________
H-Phone : ( ____) ____-________ W-Phone (____)_____-__________ E-mail _____________
CANCELLATION NOTICE
I agree to give a 90-day, advanced , written notice of intent to cancel membership in the kinetic kick program. The ninety-day cancellation period begins on the first day of the calendar month following receipt of written notice. Cancellation lasts for three calendar months or ninety days thereafter, and a tuition payment must be made for each month or thirty-day period. The membership is cancelled when all payments and fees due within notification period are paid in full.
WAIVER OF LIABILITY
1. Student represents that (s)he is in good physical condition, is not suffering from any heart, lung or other bodily alignment, and is in all respects physically fit to engage in the martial arts course.
2. Student has been advised that strict observance of the rules and regulations relative to martial arts self-defense training is mandated and includes the use of protective equipment. the school does not warrant that the protective equipment will completely eliminate the possibility of accident, injury, or death but will substantially reduce the risk of accident, injury, or death.
3. Physical contact will be used by employees of the school, other students, and authorized individuals, as part of the course of instruction. Student has been advised of such fact and gives full consent to any physical contact as may be required or customary to martial arts training.
4. In recognition of the possibility of accident, injury, or death connected with martial arts training, student waives any right or cause of action of any kind arising as the result of such activity from which any liability may or could accrue to the school, its officers, agents, employees, instructors, and/or students.
By signing below, I agree to act responsibly with the techniques that will be taught at the school. Under no circumstances shall the information learned at the school be used outside the school unless required for self-defense. I pledge to uphold the traditions and honor of the martial arts and the rules and regulations of the school. I have read all the terms set forth on the reverse of this agreement and acknowledge full responsibility to the terms and conditions stated herein as required for membership.
Kinetic Kick of New Albany