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Kingman Recreation Commission

131 W. Ave. A

P.O. Box 223

Kingman, Kansas  67068

Phone: (620) 532-2761

Fax:  (620) 532-2324



Release of Liability

Parental Acknowledgement and Release of Liability      

As in All Self Defense & Tae Kwon Do Classes, it is physical in nature.  It involves rigorous physical activity,   exercise and physical contact.  Because it is physical activity, it is recommended that the undersigned seek the advice of a doctor before beginning this or any other exercise protocol.


I, the undersigned, do hereby acknowledge and understand that I will be using the Kingman-Norwich          Recreation Commission, Kingman Armory training facility


I further acknowledge that I have been advised of the risks involved in the participation of classes and the use of equipment for such.


I acknowledge and assume any such risk to my person should I use Kingman-Norwich Recreation Commission,    Kingman Armory Facility.


In the event that I should sustain injury to myself as a result of my use of this training facility, and its       equipment, I hereby agree to hold harmless the Kingman-Norwich Recreation Commission, its board        members, employees and instructors.


I have read and fully understand the contents of this “Hold Harmless Agreement” and execute same as my own voluntary act.

Participant Name: ______________________________Signature:___________________________________

Date: ______/_______/________

Parent/Guardian Name (If participant under 18): _________________________________________________

Parent/Guardian Signature: __________________________________________________________________