Student Registration

Student's Name
Emergency Contact Name

Voluntary Waiver and Release of Liability

Please read carefully before agreeing. By checking this box, I acknowledge that I have read, understand, and agree to this waiver.
This agreement is entered into between the undersigned participant, or parent or legal guardian if the participant is under 18, and Daibudō Kodenkan Matsuno Kenshūkai (DKMK), a nonprofit martial arts organization.

Participation includes physical activities inherent to martial arts training, including but not limited to throws, falls, strikes, and conditioning exercises.

By signing this form, I voluntarily acknowledge and accept the risks inherent in martial arts training and agree to release and hold harmless DKMK, its instructors, assistants, volunteers, board members, the Kodenkan Center, and the Kodenkan Yudanshakai organization from any and all claims or causes of action, whether known or unknown, arising out of participation. I authorize DKMK staff to seek emergency medical treatment in the event that I, or my child, am injured and unable to respond. I further agree that this waiver is binding upon my heirs, executors, administrators, and assigns. If the participant is under 18, this waiver is executed by a parent or legal guardian on the participant’s behalf.

Internal & Reporting Consent

Please read carefully before agreeing. By checking this box, I acknowledge that I have read, understand, and agree to this consent.
I consent to DKMK using my (or my child’s) enrollment and progress information for internal recordkeeping and reporting to program partners and funders, including Pima County Community & Workforce Development. This information will be kept confidential and used only for administrative and reporting purposes.

Public & Social Media Consent

Please read carefully before agreeing. By checking this box, I acknowledge that I have read, understand, and agree to this consent.
I separately consent to DKMK using my (or my child’s) name, photo, video, or story in public materials, including social media, the website, and newsletters. This is optional and can be declined without affecting enrollment or eligibility for financial assistance.
Parent or legal guardian must sign for participants under 18.