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Martial Art Waiver
This template to create a waiver form for martial arts can be used to collect important information such as medical background and emergency contacts. A statement regarding health and acknowledgement of associated risks is included within this generic waiver.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes

Martial Art Waiver TemplateForm 1894
Format: Word PDF
Category: Home Life, Fitness
Type: Waiver

Martial Art Waiver

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: _____________________________________ State: ____________ Zip Code: __________________________

Phone Number: ________________________________________________________________________________

Email Address: _________________________________________________________________________________

Medical Information




Do you have a history of heart issues?

Have you ever experienced tightness or pain in your chest?

Have you had a stroke?

Do you have high or low blood pressure?

Do you have issues with severe dizziness?

Are you a diabetic?

Are you pregnant?

If you answered yes to any of the questions above you will need a doctorís release to use the Martial Art Companyís facilities.

Emergency Contact Information



Home Phone

Work Phone

Cell Phone

Martial Art Assumption of Risk & Waiver of Liability

The Student hereby represents that he / she is in good physical condition and is fully capable to use the Martial Art facilities.

The Student acknowledges that he / she is aware of the risks and hazards that are inherent in the practice of martial arts and assumes voluntarily all the risks of loss, damage or injury including the possibility of death that may be sustained by the Student or to his / her property.

In signing this Martial Art waiver the undersigned acknowledges that they have read and fully understand this release and sign it voluntarily.

Studentís Signature: ___________________________________________________________ Date: ___/___/_____

Parent or Guardianís Signature: _________________________________________________ Date: ___/___/_____