Please fill out the following

Student Name (Who is Attending?)

Phone

Belt

Age

Waiver (required) Waiver (required) I AGREE to the conditions for testing in "Event Waiver" above

Events (1 Event $45 - 2 Events $65 - 3 Events $85 - 4 Events $100) Events (1 Event $45 - 2 Events $65 - 3 Events $85 - 4 Events $100) Sparring Forms Weapons Board Breaking

How would you like to pay? (no payment required now) How would you like to pay? (no payment required now) Credit Card on File Different Credit Card Cash/Check

Event Waiver

Waiver: By filling out the form below you (“Participant” and/or “Student”) UNDERSTAND, AGREE AND ACCEPT to the following: a) the Participant will be attending classes for kata and sparring. This event brings an inherent risk and you ACCEPT and AGREE to hold Auza Li and Schneider, LLC. dba. USSD Fountain Valley, its affiliates, its instructors, staff members, assistants and all others (“Releasees”) Harmless should an accident occur to the Participant (even death and/or exposure to COVID-19) as a condition for participating whether arising from the negligence of the Releasees or otherwise. Furthermore, you AGREE and make a true representation the Participant is in good physical, and mental condition to go through this physical event. b) You agree and understand that this event incurs a cost and that payment will be collected according to your preference on the form below. All payments IN-FULL must be made BEFORE or on the date of the event and will be NON-REFUNDABLE whether or not the participant completes the classes. By signing this form you authorize Auza Li and Schneider, LLC. (or its subsidiaries) to run your card for the payment at the latest one day before the starting date, and AGREE that once this payment has been received there shall be no refunds.