Brookfield Library Opportunity to Participate December 12, 2020 1:30pm-2:30pm
Please Fill out this form so that your child can participate in a Martial Arts Lesson with JK Lee's.
Participant's First Name*
Participant's Last Name*
Parent's Full Name*
Phone*
Email*
School Location
JK Lee Brookfield 12645 W. Lisbon Rd Brookfield, WI 53005
JK Lee Waukesha 1851 E. Moreland Blvd Waukesha, WI 53186
JK Lee Lake Country N69 W25055 Indian Grass Lane Sussex, WI 53089
JK Lee Hales Corners 5301A South 108th St Hales Corners, WI 53130
JK Lee Germantown W164 N11269 Squire Dr. Suite C Germantown, WI 53022
JK Lee Fox Point 6838 N Santa Monica Blvd Fox Point, WI 53217
City Youth Martial Arts 510 E Burleigh St Milwaukee, WI 54212
I acknowledge that I am, or my minor dependent is, being granted the opportunity by J.K. Lee Black Belt Academy Brookfield Waukesha Ventures Corp., d/b/a J.K. Lee Black Belt Academy; Lee Gendelman Venture, Inc., d/b/a J.K. Lee Black Belt Academy Fox Point; Chan and Duke Lee Inc, d/b/a J.K. Lee Black Belt Academy Germantown; Chan Sara Venture LLC, d/b/a J.K. Lee Hales Corners, J.K. Lee Black Belt Academy Pewaukee; or J.K. Lee City Youth Martial Arts Program, Inc.; hereafter referred to collectively as the “School”, to watch, practice, exercise, demonstrate, participate, or receive instruction in Tae Kwon Do or other related activities at the School or at School-sponsored event(s) (hereafter referred to as the “Opportunity to Participate”). I acknowledge, further, that, absent my consent and waiver set forth in this Agreement, I would not be granted the right to do so. In consideration for my Opportunity to Participate, I hereby consent to being called or contacted by the School for offers of further services. In addition, I am aware that participation in Tae Kwon Do and other related activities, including but not limited to assisting in any manner such as holding targets, bricks and boards, can be physically demanding and involve risk of personal injury. Also in consideration for my Opportunity to Participate, therefore, I hereby release and waive, personally or on behalf of my minor dependent, any and all claims, demands and causes of action, including but not limited to claims for injuries and damages caused by the negligence of the School or its owners, officers, employees, students, agents, or volunteers, arising out of or related in any way to any injury that I or my minor dependent might sustain as a result of my or my minor dependent’s participation in or attendance at the School’s lessons, classes, tests, tournaments, or any other sponsored event. I further agree to indemnify the School for and to hold the School harmless from any and all claims related in any way to any such injury to me or to my minor dependent, including any claim or injury resulting in any way from the negligence of the School or its owners, officers, employees, students, agents, or volunteers. In further consideration for my Opportunity to Participate, I hereby give my consent to the School’s instructors and staff, or any medical personnel secured by the School, to treat me or my minor dependent in the event of any injury or illness, and I authorize the School to release to any such medical personnel or other medical provider any and all medical records in the School’s possession or control concerning me or my minor dependent as the School, in its sole discretion, determines reasonable for the care or treatment of me or my minor dependent. Also in consideration for my Opportunity to Participate, I hereby grant the School permission to photograph, video, or otherwise record, in any medium now known or later created, my or my minor dependent’s performance, whether during lessons, classes, practice sessions, tests, fairs, tournaments, or other outside events, or otherwise, hereafter referred to collectively as the “Photographs”. I acknowledge that the School owns all copyrights in and to the Photographs, and I hereby transfer and assign to the School any copyright that I have or may have in any such Photograph. I also hereby grant to the School and its legal representatives and assigns the irrevocable and unrestricted right to use and to publish any such Photograph for editorial, website, trade, advertising, or any other purpose and in any manner or medium; to alter any such Photograph without restriction; and to copyright any such altered Photograph. I hereby release the School and its owners, officers, legal representatives, agents, attorneys, and assigns from all claims and liabilities relating in any way to the Photographs and their use.
I have read terms of this opportunity to participate set forth below and agree to them voluntarily and of my own free will.*
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