ONLINE REGISTRATION FORM

Student Name

Date of Birth

Mailing address: , ,

Please note that your payment will be processed by Team Raposa, LLC.

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Team Raposa is a premier Martial Arts and Fitness institution. Cultural Integration & Arts Association, popularly known as CINA, is in partnership with Team Raposa for programming and student management. I hereby authorize Team Raposa, LLC to charge my account in the agreed upon amount. I also agree that future incidental fees that are not stated in this form (such as materials or various out-of-school fees) will be charged upon my authorization. I authorize Team Raposa, LLC to collect a return debit NSF fee of $25 per item by electronic debit from the same account.

 I agree to allow Team Raposa, LLC to use photos and videos of my child or myself taken during the lessons, promotion or other events. 

 I understand that 6-month and 12-month contract membership options are available at discounted rates. By choosing one of these membership options, I agree to complete the entire contract membership period, with the option of renewing at the end. If I terminate this agreement before the end of the contract period, I agree to pay a termination fee in the sum of 50% of the sum of the remaining tuition in the contract period. 

The student is aware in making this agreement to participate in training in the Team Raposa, LLC that certain elements of this training are physically demanding and potentially dangerous, and with this knowledge agrees to indemnify and hold harmless from all losses caused by accident or injury the Instructor, his assistants, or any third parties who may be students of the same class or who are students with the Instructor, in the event that the student or that said third party is injured in any way during the proper performance and execution of techniques or instruction provided in this training. 

               This release shall also include any landlord or leaseholder of any training facility in which training is conducted. I also agree that the terms hereof shall serve as a release and assumption of risk for my heirs, executors and administrators, and for all members of my family, including any minors.

               The student attests that he/she is in good physical condition and has no known or suspected medical conditions that would preclude vigorous physical activity. 

               It is further agreed that the student’s name, photograph or other representation for the purposes of promotion or publicity for this Taekwondo program or the instructor/school may be used.

               As part of the consideration for participation, the student acknowledges and assumes all these risks and wishes to enroll in this course of instruction. 

               I have cleared out the training area of any unsafe items that may obstruct your practice. 

It is recommended that participants have a checkup by a physician before beginning any new physical regimen.

COVID-19

ACKNOWLEDGMENT AND DISCLOSURE

               The student is aware in making this agreement to participate in training in the Team Raposa, LLC that certain elements of this training are physically demanding and potentially dangerous, and with this knowledge agrees to indemnify and hold harmless from all losses caused by accident or injury the Instructor, his assistants, or any third parties who may be students of the same class or who are students with the Instructor, in the event that the student or that said third party is injured in any way during the proper performance and execution of techniques or instruction provided in this training. 

               This release shall also include any landlord or leaseholder of any training facility in which training is conducted. I also agree that the terms hereof shall serve as a release and assumption of risk for my heirs, executors and administrators, and for all members of my family, including any minors.

               The student attests that he/she is in good physical condition and has no known or suspected medical conditions that would preclude vigorous physical activity. 

               It is further agreed that the student’s name, photograph or other representation for the purposes of promotion or publicity for this Taekwondo program or the instructor/school may be used.

               As part of the consideration for participation, the student acknowledges and assumes all these risks and wishes to enroll in this course of instruction. 

               I have cleared out the training area of any unsafe items that may obstruct your practice. 

It is recommended that participants have a checkup by a physician before beginning any new physical regimen.

   I understand that during this COVID-19 Public Health Emergency I will NOT be permitted to enter the facility beyond the designated drop-off and pick-up area.  I understand that this procedure change is for the safety of all persons present in the facility and to limit to the extent possible everyone’s risk of exposure. On the occasion that you must stay, seating will be limited and strict social distancing measures will be in place. Parents will have the ability to follow along with their child’s class remotely.  

    I understand that IF there is an emergency requiring me to enter the facility beyond the designated drop-off and pick-up area, I MUST sanitize my hands before entering, remove my shoes and wear a mask.  While in the facility I must practice social distancing and remain 6ft from all other people, except for my own child.  

    I understand that to enter the studio premises my child must be free from COVID-19 symptoms.  If, during the day, any of the following symptoms appear my child will be separated from the rest of the people in the studio.  I will be contacted, and my child MUST be picked up from the studio within 15 minutes.

Symptoms include, 

·  fever of 100.4 degrees Fahrenheit or higher

·  dry cough

·  Shortness of Breath

·  Chills

·  Loss of taste or smell

·  Sore Throat

·  Muscle aches

While many of these symptoms might be non-COVID-19 symptoms we are proceeding with by assuming they are Covid-19 during this Public Health Emergency.  These symptoms typically appear 2-7 days after being infected so please take them seriously.  You will need to be symptom free for 72 hours before returning to the facility.

     I understand that my child must always wear a mask while in the studio and on studio premises.  

    I understand that students will be required to bring their own hand sanitizer and use it according to CDC recommended handwashing procedures every time they touch a surface in the studio. 

    Each student MUST remove their shoes before entering the training area.  Those shoes will be put into a “dirty bag” and placed inside their personal gear bag.

    I understand that outside of martial arts, all students will comply with all state, county or local stay-at-home orders, and all contact with persons living outside our household will follow all state, county or local stay-at-home orders.  My student and our family will comply with any and all state, county or local stay-at-home orders, will limit contact outside of the Academy to persons living in our household and will only go out to inside venues in which we can maintain a minimum 6 foot social distancing.  I will follow any recommendations from the CDC that limits my risk for exposure including wearing a mask in all public areas and remaining 6ft from all other people. 

    I will immediately notify [TEAM RAPOSA] management if I become aware of any person with whom my child or I have had contact exhibits any of the symptoms listed in Number 1 above, is advised to self-isolate, quarantine, or has tested positive, or is presumed positive for COVID-19.  Further, I will immediately notify [TEAM RAPOSA] management if anyone from my place of employment is presumed positive or tests positive for COVID-19 whether or not I have had direct contact with that person. 

    I understand that Students entering our studio will be in contact with children, families and  employees who are also at risk of community exposure.  I understand that no list of restrictions, guidelines or practices will remove 100% of the risk of exposure to COVID-19 as the virus can be transmitted by persons who are asymptomatic and before some people show signs of infection.  I understand that I play a crucial role in keeping everyone in the facility safe and reducing the risk of exposure by following the practices outlined herein.

 I, certify that I have read, understand, and agree to comply with the provisions listed herein.  I acknowledge that failure to act in accordance with the provisions listed herein, or with any other policy or procedure outlined by [TEAM RAPOSA] will result in disciplinary action up to and including termination of membership.  I acknowledge that my employment will be terminated if it is determined that my actions, or lack of action unnecessarily exposes another student, their family member, or instructor to COVID-19.

Parent 1

Parent 2

Student