SPECIAL INTRODUCTORY PROGRAM
$29 plus a FREE Uniform

This form will serve as a Participation/Waiver form for the participant(s) named here. Busho Kai, upon receipt of this completed form, will send an email to the Parent/Guardian email address indicated on this form to confirm your identity and permission of your eligible child(ren)to attend the event.

I, as a legal parent/guardian, allow my child(ren)(Participants named above) (minor[s]) to participate in Busho Kai USA, Inc. Parent’s Night Out. Further, as legal representative of said minor(s), hereby release and forever discharge the owners, promoters, instructors, staff members, building or property owners and/or their assigns and all participants from any and all claims, actions, injuries, and personal or property damages that might occur to said minor(s) as a result of participation in the activities. I do hereby give Ivan Lewis and/or his assigns permission to administer first aid to said minor(s) or take minor(s) to an emergency medical center should the need arise. By evidence of my signature below, I agree and understand all terms, statements, and conditions as written above.

NOTE: This form MUST be received with all necessary fields completed before your child(ren) will be permitted to attend. Once completed, please click on the Buy Now button on the page below to use PayPal or your Credit Card to purchase tickets to this event for each participant indicated on this form. Thank you and we hope to see your child(ren) at this event!