Student Name *

Please complete and sign this form prior to participating 2024 camp or drop off programming at ‘Ohana Martial Arts. Completed forms must be submitted online.

First Name

Last Name

Primary Phone Number for Emergency *

(###)

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Secondary Phone Number for Emergency *

(###)

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Other Emergency contact

(###)

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Would you like to receive emails about future dojo happenings? *

Yes

No

I already get emails

Permission to use images of your student 'Ohana Martial Arts is authorized by to use video or photographs of your student for advertising, publicity and public relations. Video-footage will only be used by 'Ohana Martial Arts Non-profit Self-defense School. No further claims may be made. If there is a court ordered safety issue with use of photos/videos such as foster children please let us know in advance. *

Agree

Agree, but for exceptional reasons please try to remove pictures of my child from advertising, publicity and public relations. (We will try our best, but please know it is not illegal to use pictures from public settings of large groups at camp).

Emergency Care By checking this box I agree that if 'Ohana Martial Arts Non-Profit Self-Defense School are unable to contact the emergency contact on file and 'Ohana Martial Arts supervisor on duty determines your student is ill or injured and needs emergency care - emergency medical staff will be called. If medical staff determines camper needs treatment it will be provided and billed to campers family. *

Agree

Full Responsibility Waiver I, _____________________________, take sole responsibility for any personal injury I (or my participating family members) may incur over the course of any and all 'Ohana Martial Arts Non-Profit Self-Defense School programs we may participate in. I acknowledge that participation in this program exposes me to potential risks and I release all instructors or fitness coaches from any and all liabilities regarding an injury and will cover all medical costs associated with injuries from participation. I shall not now or in the future prosecute any lawsuit against 'Ohana Martial Arts non-profit self-defense school or its directors, board of directors or instructors. I’m aware that this agreement will be legally binding. I have read and understood this Injury Waiver and Medical Release Form as a participant or a parent/guardian.

Agree

Discipline: Appropriate firm but kind discipline is used to insure safety for all staff and students. All children are expected to respect themselves, others and all property. Sitting out from activities will be enforced if a student is acting in an unsafe manner. If persistent or severe behavior problems are interrupting programing or endangering students or staff, parents/guardians will be contacted to remove their student from the program immediately. We realize our program is not for everyone, please use your discernment as to if this type of active, busy, potentially loud outdoor program is best for your child. They need to be able to safely operate in an up to 10:1 ratio for campers under 6 and up to 20:1 staff to camper ratio for 8 and older. 'Ohana Martial Arts Non-profit Self-Defense School reserves the right to refuse any student from future programming. I give 'Ohana Martial Arts Non-profit Self-Defense School the authority to exercise these discipline policies in regard to my camper or student and will be available should my student be persistently disrespectful or unsafe.

Agree

I understand that there are risks in attending camp and me or my family may be inadvertently exposed to illness, including COVID. ‘Ohana Martial Arts follows all laws and regulations and should Kona have widespread community spread of any illness or virus, this camp may close for the protection of the participants and community. I release 'Ohana Martial Arts, all instructors or fitness coaches from any and all liabilities regarding illness, closures and will cover all medical costs associated with illness from participation. I shall not now or in the future prosecute any lawsuit against 'Ohana Martial Arts non-profit self-defense school or its directors, board of directors or instructors. Campers and staff with active cold symptoms are not allowed at camp. We will safely isolate campers with new symptoms until you come to pick them up. Parents or gardians are expected to be available or have an appointed adult able to come pick up sick campers. *

Agree