Release

Thank you for your interest in having yourself or your child attend a free karate class. Please fill out the following form and agree to the terms.

We are looking forward to seeing you at the dojo!

    Your Name

    Your Email

    Your Phone Number

    Student Name

    Student Age

    Name of Host Student

    What Day Do You Want To Come In



    Acknowledgment and Disclaimer:
    United Studios of Self Defense reserves the right to dismiss any student at any time without refund for misconduct which may convey a negative image
    or be deemed harmful to the Instructors, other Students, or property located within and around these premises. I hereby acknowledge that United Studios
    of Self Defense, its officers, Instructors, agents and subcontractors are not responsible for any injuries or damages suffered while on or around these
    premises; additionally I accept fully responsibility for my own safety and understand the risks involved in my /child's participation in these activities.

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