Child Application and Payment

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Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Evolution, MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is no refund policy on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18.
I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Back Creek Christian Academy, CCAC, and Eastside Church, MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is no refund policy on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18..
I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Valor Preparatory Academy, MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings. I understand there is a NO REFUND POLICY on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18.

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Checkmat NC, Patrick Culbertson, Paulo Elsimaani, MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is no refund policy on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18..
I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Charter Schools USA and Concord Lake STEAM Academy, MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is no refund policy on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18..
I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Mallard Creek Stem Academy (MCSA), MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is no refund policy on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18..
I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve, Charter Schools USA and Langtree Charter Academy, MATI Clubs, MATI, its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings. I understand there is a NO REFUND POLICY on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18.

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve, Charter Schools USA and Steele Creek Preparatory Academy, MATI Clubs, MATI, its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings. I understand there is a NO REFUND POLICY on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18.

Please Check Box The You Agree to the Following;*

In consideration for my attendance and participation in this academy’s martial arts training, I, the student/ parent/ legal guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Carolina International School (CIS), MATI Clubs, M.A.T.I., its management, assigned staff, and fellow students, from any liability resulting in personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I grant and authorize MATI Clubs the right to take, edit, alter, copy, exhibit, publish distribute and make use of any and all pictures, video and/or audio taken of applicant to be used in and/or for any lawful promotional materials, included, but not limited to newsletters, flyers, posters, brochures, advertisements, websites, social networking sites and other print or digital communications without payment or any other consideration. I waive the right to inspect or approve the finished product wherein the applicant’s likeness appears, including written or electronic copy and waive any right to royalties or other compensation arising or related to the use of these images or recordings. I understand there is a NO REFUND POLICY on any monies I will pay to this academy or representative of said academy. A parent or legal guardian signature is required if the student is under the age of 18.

Student's First Name*

Student's Last Name

Age

Birth Date

Shirt Size

Parents/ Legal Guardian Name

Street Address

Street Address 2

City, State, Zip

Home Phone

Cell Phone

What specifically would you like your child to accomplish in our martial arts program?

School

Grade

Teacher

Describe Your Student

Other Activities

Medical Concerns

PLEASE SELECT BELOW EACH COLUMN IN ORDER OF IMPORTANCE, FROM 1 TO 4 Self-Confidence (self-esteem, assertiveness, pride) Physical Fitness (weight control, strength & flexibility, coordination) Self-Discipline (concentration, self control, integrity) Self-Defense (safety, confidence, awareness)

Order of Importance

Price

Total

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Card Details

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