Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 7Payer Name *FirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Payer Email *Number of Students *Single Student- monthlyTwo Students- monthlyThree Students-monthlyFour+ Student MonthlyPer month for two classes a week.NextStudent #1 Name *FirstLast Date of Birth #1 *Same Address #1Address same as main address above.Address 1 *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent #1 Medical Concerns *PreviousNextStudent #2 NameFirstLast ACCEPTANCE AND Student Date of Birth #2Same Address 2Address same as main address above.Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent #2 Medical Concerns *PreviousNextStudent #3 NameFirstLastDate of Birth 3 *Same Address 3Address same as main address above.Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent #3 Medical Concerns *PreviousNextStudent #4 NameFirstLastDate of Birth 4 *Same Address 4Address same as main address above.Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent #4 Medical Concerns *Other Students InfoOther Student Medical Concerns *PreviousNextWAIVER AND RELEASE OF LIABILITY/ASSUMPTION OF RISK: *The Member understands and agrees that the use of Stick Warrior Martial Arts’ facilities and the Member’s presence at Stick Warrior Martial Arts’ facility are at the sole risk of the Member. The Member understands and agrees that martial arts involves skills and training which include violent and sudden movements and that in connection with the training and instruction there will be physical contact between instructors and Members and between and among Members and that such contact may result in personal injury to the Member; despite precautions being taken to prevent such injuries. Members hereby consent to engage in such contact as may be necessary or required by Member’s participation in the training programs and/or classes and assume all risks associated with such training and participation. Member, on behalf of him/herself and anyone claiming by or through the Member, hereby holds harmless, releases, and forever discharges Stick Warrior Martial Arts, its instructors, agents, employees, operators, landlord, and authorized representatives from any liability, claim, loss of property, damage, personal injury, or expense incurred by the Member and arising from the Member’s execution of this agreement, payment processing, participation in any program offered by Stick Warrior Martial Arts, including, but not limited to, any injury or damage caused by the negligence or willful misconduct of Stick Warrior Martial Arts, its instructors, members, agents, employees, operators, and authorized representatives.STUDENT FITNESS: *By signing this agreement, Member represents, warrants, and insures that he/she has had an opportunity to observe the programs offered by Stick Warrior Martial Arts and that, in lieu of a medical certificate signed by a medical doctor, he/she has no knowledge of any physical or mental impairment that would be affected by the named student’s participation in programs offered by Stick Warrior Martial Arts.EMERGENCY MEDICAL TREATMENT: *I hereby authorize Stick Warrior Martial Arts, to act for me in the event of any emergency requiring immediate medical attention. All medical expenses incurred will be the responsibility of the Member or Member’s family.CANCELATION: *If by reason of death or permanent disability, the buyer is unable to continue the membership, buyer or buyer's estate shall be relieved from the obligations of this contract, and if buyer has prepaid any sum, that amount shall be refunded except Stick Warrior Martial Arts may retain expenses actually incurred and the portion of the total price representing the services used and complete. The members understand that they have the right to cancel this agreement at any time during the agreement as long as they notify Stick Warrior Martial Arts 30 days in advance with a written cancellation notice. FAILURE TO ATTEND CLASS DOES NOT CONTITUTE OR IMPLY NOTIFICATION TO OR CANCELLATION OF THIS AGREEMENT. The member understands the agreement is active until such cancellation notice has been delivered and the payment of any balance has been made.DEFAULT AND LATE PAYMENT: *Should you default on any payment obligation as is called for in this agreement, the entire remaining balance shall be deemed due and payable upon demand, and you agree to pay allowable interest, and all costs of collection, including, but not limited to, collection agency fees, court costs and attorneys’ fees. Should any monthly payment become more than 10 days past due, you will be charged a late fee to cover additional administrative expenses and other expenses related to obtaining your payment. A fee will be charged for all returned payments.INSTRUCTION: *Scheduling and content of classes and programs, furnishing of facilities and provisions of instructors to teach and supervise classes and practice sessions are at the sole and absolute discretion of Stick Warrior Martial Arts and may be changed at any time by Stick Warrior Martial Arts. Members understand that examination and testing fees, seminars, and special events may not be included in the price of this agreement. Stick Warrior Martial Arts may raise the tuition rate of ongoing memberships by providing advance notice equal to the notice period required for cancellation stated herein.ACCEPTANCE OF MEMBER: *By signing this agreement, Member agrees to fully and completely comply with all terms and conditions hereof and Stick Warrior Martial Arts’ rules and regulations. Failure to comply with Stick Warrior Martial Arts’ rules and regulations is grounds for immediate suspension or termination of the Member. Suspension or termination shall not entitle the Member to a refund or credit for tuition already paid or cancel any unpaid balance due. The failure or inability of the Member to use the facilities, classes, or services of Stick Warrior Martial Arts for any reason, except as otherwise provided herein, does not relieve or suspend the Member’s obligation to make payments required under this agreement on a timely basis, nor entitle the Member to a refund or credit. Unless otherwise indicated on the front page of this agreement, upon the expiration date of this agreement, the agreement will automatically renew as an agreement on a month-to-month basis, and all provisions of this agreement shall remain in full force. Members understand and agrees that full payment of tuition is not a guarantee or promise of advancement. Stick Warrior Martial Arts and those acting under its authority reserve the right to use written statements, photographs, videotapes, artwork or other likenesses of the Member for marketing, trade, publishing, or any other lawful government purpose.PreviousNextSubmit Registration