register

Click here if you would rather download the registration form to deliver to Soja in person



Soja Kids Registration
#1 Student: Male Female Age:
Date of Birth
#2 Student: Male Female Age:
Date of Birth
Parent/Guardian #1: Home: Work:
Email: (Soja does not share mailing lists or e-mail addresses) Cell:
Address/City/Zip:
Parent/Guardian #2: Home: Work:
Email: (Soja does not share mailing lists or e-mail addresses) Cell:
Address/City/Zip:
Emergency Contact other than above numbers: To be used if first two parents/guardians indicated above cannot be reached: Telephone:
Medical Doctor: Telephone
Student Special Needs: Please explain if you or your child has any special physical, behavioral, learning, or medical needs. List all serious allergies. Attach additional sheet if necessary.
How did you hear about us?
Please list history of any martial arts programs you or your child has already participated in. Also, please list class(es) student is enrolled in (which day school, and any other martial arts or other physical education programs outside of their daily school)

2010 Summer Camp Schedule Selection
1st Student
Week 1 (6/21-6/25) Half Day or Full Day
Week 2 (6/28-7/2) Half Day or Full Day
Week 3 (7/5-7/9) Half Day or Full Day
Week 4 (7/12-7/16) Half Day or Full Day
Week 5 (7/19-7/23) Half Day or Full Day
2nd Student
Week 1 (6/21-6/25) Half Day or Full Day
Week 2 (6/28-7/2) Half Day or Full Day
Week 3 (7/5-7/9) Half Day or Full Day
Week 4 (7/12-7/16) Half Day or Full Day
Week 5 (7/19-7/23) Half Day or Full Day
*There is a non-refundable $30 deposit on each week enrolled if a child must withdraw prior to the first day of camp. Transfers prior to the first day of camp are subject to a $25 fee per transfer. All paid tuition is non-refundable and non-transferable as of the first day of the session.
 
 
 
Participant Agreement, Release, and Assumption of Risk
PART 2: VOLUNTARY PARTICIPATION. I am aware that marital arts and yoga activities can be hazardous activities. My minor child/ward is or I am voluntarily participating in these activities, and using the facilities of Soja Mind/Body Kung Fu, herein after referred to as “Soja”, with knowledge of the danger involved and hereby agree to assume full responsibility, including legal and financial responsibility for, and to accept, any and all risks of property damage or loss and bodily injury, including but not limited to injuries resulting from landing, falling, injuries to bones, joints, ligaments, or tendons, head injuries, or loss of life.
PART 3: ASSUMPTION OF RISK. In consideration for allowing my child to participate, I hereby assume all the risks associated with the activities of martial arts and yoga and agree to hold Soja, its officers, employees, teachers, coaches and staff harmless from any and all
liability which may arise in connection with my or my child(ren)’s participation in any activities related to the program. The terms here of serve as a release.
PART 4: STATEMENT OF HEALTH AND HEALTH INSURANCE. I hereby certify that my minor child or ward or I am in good health has/have no physical limitations which would preclude his/her/me from safe participation in a variety of martial arts and/or yoga activities and/or other activities.
PART 5: RELEASE AND WAIVER OF LIABILITY. As a consideration for my minor child or ward or myself being permitted by Soja to participate in martial arts and/or yoga activities, or other activities, I here by forever release and discharge Soja and its predecessors, officers, directors, employees, successors, insurers, representatives, and all affiliates from all litigation, actions claims, and demand of every kind that my assign, successors, heirs, spouse, administrators, guardians, insurers and legal representatives have now or may hereafter have for injury or damage resulting from my or my minor child(ren)’s or ward’s participation in Soja’s programs.

ADULT CLASS Participants (18 years & older).
Please read carefully! I understand that in the event of injury or accident no insurance coverage of any kind is available except that which I provide myself at my own expense.
 
4. Should Soja, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and reimburse them for such fees and costs.
5. I certify that my child has health, accident and liability insurance to cover any bodily injury or property damage that may be caused or suffered while participating in this event or activity, or else I agree to bear the costs of such injury or damage to my child. I further certify that I am willing to assume the risk of any medical or physical condition my child may have or else I am willing to assume and bear the costs if all risks that may be created, directly or indirectly, by any such condition.
6. In the event that I file a lawsuit against Soja, I agree to do so solely in the state of California, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforcebeable, the remaining portions shall remain in full force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Soja on the basis of any claim from which I have release herein. I have had sufficient opportunity to read this entire document. I have understood it, and I agree to be bound by its terms.
Signature of Participant or Parent/Guardian & Date
Print Name
Address
Home Phone
Work/cell Phone
 
PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION
(Must be completed by participants under the age of 18)
 
In consideration of (print minor’s name )
(“Minor”) being permitted by Soja to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless Soja from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Parent/Guardian Signature
Print Name
Date:
 
 
 
Soja Martial Arts
2406 Webster Street, Oakland, CA 94612
510.832.7652 www.sojamartialarts.com