Zakaria Islamic Academy Martial Arts Program –  Waiver and Release of Liability.
Event Name : Zakaria Islamic Academy Martial Arts Program

Event Address: 26243 Gum Spring Rd, Chantilly, VA 20152

Phone: (571) 969-2123
Program Details:
Instructor:  Jaber Hossain
Focus on Self Defence
Duration: 8 weeks, starting June 24th
Mon, Tue, Wed
Asr (6:30) – Maghrib (8:30)
Batch 1 (ages 7-12) – 6:30 – 7:30
Batch 2 (ages 13+, including adults) – 7:30 – 8:30
Maximum 20 students per batch
Payment Information:  $150 for total 8 week course (24 classes) per student
Method:  https://us.mohid.co/va/richmond/zia/masjid/online/donation
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Student's Name
Parent/Guardian Name (if applicable)
Gender (Male only class)
Address

I, the undersigned, understand that participating in martial arts classes and activities at Zakaria Islamic Academy involves inherent risks, including but not limited to, physical injury, illness, or property damage. I  acknowledge and accept these risks. In consideration of being permitted to participate in the martial arts  program at Zakaria Islamic Academy, I agree to the following:

1. Assumption of Risk: I voluntarily assume all risks associated with participation in the martial arts program, including but not limited to, injuries resulting from physical contact, falls, or the actions of other participants.

2. Release of Liability: I release, discharge, and hold harmless Zakaria Islamic Academy, its instructors, staff, volunteers, and any other participants from any and all claims, liabilities, demands, or causes of action arising out of or related to my participation in the martial arts program.

3. Medical Treatment: Zakaria Islamic Academy does not cover any medical treatment for me in case of injury or illness. I understand that I am responsible for all medical expenses incurred because of my participation in the martial arts program.

4. Compliance with Rules: I agree to comply with all rules and regulations set forth by Zakaria Islamic Academy and its instructors. I understand that failure to comply may result in my dismissal from the program.

5. Photography/Videography Release: I grant permission for Zakaria Islamic Academy to use photographs or videos taken of me during classes and events for promotional purposes.

By accepting below, I acknowledge that I have read and understand this waiver and release of liability. I voluntarily agree to its terms and conditions.

Accept/Deny
Price: $150.00
Please enable JavaScript in your browser to complete this form.
Student's Name
Parent/Guardian Name (if applicable)
Gender (Male only class)
Address

I, the undersigned, understand that participating in martial arts classes and activities at Zakaria Islamic Academy involves inherent risks, including but not limited to, physical injury, illness, or property damage. I  acknowledge and accept these risks. In consideration of being permitted to participate in the martial arts  program at Zakaria Islamic Academy, I agree to the following:

1. Assumption of Risk: I voluntarily assume all risks associated with participation in the martial arts program, including but not limited to, injuries resulting from physical contact, falls, or the actions of other participants.

2. Release of Liability: I release, discharge, and hold harmless Zakaria Islamic Academy, its instructors, staff, volunteers, and any other participants from any and all claims, liabilities, demands, or causes of action arising out of or related to my participation in the martial arts program.

3. Medical Treatment: Zakaria Islamic Academy does not cover any medical treatment for me in case of injury or illness. I understand that I am responsible for all medical expenses incurred because of my participation in the martial arts program.

4. Compliance with Rules: I agree to comply with all rules and regulations set forth by Zakaria Islamic Academy and its instructors. I understand that failure to comply may result in my dismissal from the program.

5. Photography/Videography Release: I grant permission for Zakaria Islamic Academy to use photographs or videos taken of me during classes and events for promotional purposes.

By accepting below, I acknowledge that I have read and understand this waiver and release of liability. I voluntarily agree to its terms and conditions.

Accept/Deny
Price: $150.00