Krav Maga Liability Form

KRAV MAGA MINOR LIABILITY WAIVER & PERMISSION PACKET

Commonplace Homeschool Cooperative - Sisters, OR

Instructors: B. Ashtyn Moyle & Timothy Hopper

Affiliation: Krav Maga Worldwide

SECTION 1 - LIABILITY WAIVER

Minor Participant Information

Child's Full Name

Child's Birthday

Month

Day

Year

Parent/Guardian Name

Phone

I. Parties Covered by This Agreement

This Agreement is executed by the undersigned parent or legal guardian (“Guardian”) on behalf of the minor participant (“Child”) in favor of:

- B. Ashtyn Moyle

- Timothy Hopper

- Commonplace Homeschool Cooperative

- Krav Maga Worldwide

- All officers, volunteers, assistants, agents, and affiliated entities

II. Acknowledgment of Inherent Risks

Guardian acknowledges that Krav Maga is a full-contact martial-arts/self-defense system involving strenuous physical activity and controlled physical engagement. Risks include bruises, sprains, fractures, concussions, accidental impacts, and risk of death inherent to full-contact training.

III. Assumption of Responsibility

Guardian affirms the Child is physically, mentally, and emotionally capable of participating and accepts full responsibility for any injury or harm sustained during or after participation.

IV. Release of Liability

Guardian releases and discharges all listed parties from any liability related to injuries resulting from full-contact training or ordinary negligence.

V. Indemnification

Guardian agrees to indemnify and hold harmless all Released Parties from any claims arising from the Child’s participation.

VI. Medical Authorization

Guardian authorizes emergency medical care for the Child and accepts financial responsibility for all resulting costs.

VII. Media Release

Guardian does or does not grant permission for the Child to appear in photos or videos taken during class, with the understanding that the Child’s face will not be publicly posted online.

I do give permission

I do NOT give permission

EMERGENCY CONTACT INFORMATION

Primary Contact Name

Relationship

Phone

Secondary Contact Name (Optional)

Relationship

Phone

Please list all medical conditions/allergies

Parent/Guardian Signature

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Today's Date

SECTION 2 - CHILD PARTICIPATION PERMISSION SLIP

Please check each box to indicate consent

My child is permitted to participate in the Krav Maga-based classes at Commonplace Homeschool Cooperative in Sisters, Oregon

I understand that Krav Maga is a full-contact sport that comes with inherent risks, including the possibility of both minor or series inury, risks that are present in most sports

My child is physically, mentally, and emotionally capable of participating in this course. We understand that all techniques are participatory, and that the student can decline participation at any time, for any technique

My child has my permission to choose to engage in sparring when offered (Krav Club only)

My child has permission to engage in self-defense drills, including simulated chokes and bear hugs, defenses against various strikes, and to engage in the action of sending strikes, and bodily movements such as rolls on the ground

My child has permission to participate in classes taught by Timothy Hopper of Cascadia Krav Maga, who has submitted a background check to Commonplace Co-Op

I consent to my child being photographed or video-recorded during class, with the understanding that my child's face will not be publically posted online

Child's Full Name

Parent/Guardian Name

Parent/Guardian Signature

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Today's Date

KRAV MAGA MINOR LIABILITY WAIVER & PERMISSION PACKET

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