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WarriorRage KickBoxing Federation Home Officials Training Book for Combat Sports (standard) WR Publishing |
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All participants will need to fill out the waiver of Liability form and send with payment made to Scott Bolinger (WRKF) at 507 Niobrara Alliance Nebraska 69301.WarriorRage KickBoxing Federation(WRKF)Membership Form
Last Name: __________________________ First Name: __________________________ (print) Address ______________________________ ______________________________ Phone # ______________________________________ Email address: _________________________________ Website: ______________________________________
Martial arts style: _____________________________________________ School Name: _____________________________________________ Type of membership: ______ Single ______ Group Members: ________________________________ _________________________________
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___ $100 for group membership
Signature of primary member: ___________________________ Date: ____________
Staff Signature: _______________________________________
WarriorRage KickBoxing Federation(WRKF)
Management: Manager: Scott Bolinger Address: 507 Niobrara City and State: Alliance, Nebraska 69301 Phone: 308-762-3382
Waiver of Liability
I hereby agree to the policies and rules of the WRKF and knowledge of violation of such policies may be the cause of revocation of member privileges without refund of membership dues.
To Participate, I, the Undersigned, do hereby agree to hold, now and in the future, the county of Box Butte, Morrel and Dawes, in the state of Nebraska, and the WarriorRage KickBoxing Federation, their officers, agents, and employees free from liability for any personal injury or damages incurred as a result of participation in a program sponsored by the WarriorRage KickBoxing Federation.
I hereby acknowledge the risk of injury that is possible through any/all programs that are WRKF related in exercise activities, equipment, Boxing and Mixed Martial Arts and all WRKF activity programs/classes and agree to hold free from and liability of the WRKF, and forever discharge and all rights and claims for damages which I may have or hereafter occur. Any protective equipment for any/all programs that are not provided by the WRKF are the responsibility of the participant and / or parent to make sure they their child wear and provide them/self any/all equipment that may be extra protection for the safety of them / or their child from injury.
The agreement includes freedom from prosecution by relatives and heirs as well.
Furthermore, I/we know of no impairment of deficiency in physical health or otherwise that would limit or prohibit _________________________(registrant’s name) from participation in practice sessions and/or game competition I/we agree to advise and make know to the instructor and/or officials any change in the physical health or any other consideration that would limit or prohibit the above-named student from participation in practice sessions, games, or other WRKF Activities.
CONSENT FOR MEDICAL TREATMENT In the event that my child or I require emergency medical treatment or hospitalizations while at the Warrior Rage KickBoxing Federation center, I hereby give my permission for a rescue squad to be called, and for emergency medical treatment to be given by the rescue squad. In addition I give my permission, pending arrival of a rescue squad, for emergency treatment to be provided by the WarriorRage KickBoxing Federation and if deemed necessary for my child of myself, to be transported to the nearest hospital.
Signature of Parent/Guardian: __________________________ Date ______________________ Print: ___________________________________ If 19 or older sign here: _______________________ Date __________________ Print: ___________________________________
For Adult _____ Child _____ DOB: _____________ Staff Signature: ___________________________________________
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