RYZE MARTIAL ARTS FITNESS ACADEMY AFTERSCHOOL PROGRAM WAIVER & AGREEMENT
Participant Information
Child’s Name: {name}
Age: ___________ Date of Birth: {dob}
Parent/Guardian Name:
Primary Phone Number: {phone}
Email:
Address: {address}
Emergency Contact (Other than Parent/Guardian)
Name: {contact_name}
Relationship: {contact_relation}
Phone Number: {contact_phone}
Authorized Individuals for Alternate Pickup
(Individuals authorized to pick up your child other than the parent/guardian)
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Name: Phone: Relationship:
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Name: Phone: Relationship:
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Name: Phone: Relationship:
? Important:
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A valid photo ID must be presented for pickup verification.
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Unauthorized individuals will NOT be allowed to pick up your child.
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Any changes to this list must be submitted in writing to Ryze Martial Arts Fitness Academy.
1. Program Overview
The Ryze Martial Arts Fitness Academy Afterschool Program runs Monday-Friday from 2:30 PM – 5:00 PM, with a mandatory pickup window from 5:00 PM – 5:30 PM. Students will participate in structured activities including:
✅ Homework Time
✅ Snack Time (Bring Your Own)
✅ Brazilian Jiu-Jitsu (BJJ) Training
✅ Muay Thai Training
2. Pickup Policy (Mandatory Pickup – No Walkers Allowed)
? Walkers are NOT permitted—all students must be picked up by an authorized adult.
? Students may NOT wait outside or wander in the parking lot. They must remain inside the facility until picked up.
⏳ Late pickups past 5:30 PM may result in additional fees or removal from the program.
3. Late Pickup Fees & Transition to Full Youth Class
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Late Pickup Fees: $10 per 15-minute increment after 5:30 PM.
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If a student stays past 5:30 PM and participates in the 5:30 PM Youth Class five (5) times within a billing cycle, their rate will automatically adjust to the full Youth Membership ({membership_fees}) moving forward.
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No exceptions. This ensures fairness and proper class structure.
4. Behavior & Conduct
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Students are expected to respect instructors, classmates, and facility rules.
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Any form of bullying, disrespect, or misconduct may result in suspension or removal from the program.
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Parents will be notified immediately if behavior issues arise.
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Behavior Tally System: Recurring behavioral issues will be tracked using a tally system.
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1st tally: Verbal warning and parent notification.
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2nd tally: Written warning requiring parent acknowledgment.
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3rd tally: Meeting with parent/guardian and possible suspension.
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4th tally: Removal from the program if behavior does not improve.
5. Liability Waiver & Release
I, the undersigned parent/guardian, acknowledge that participation in the Ryze Martial Arts Fitness Academy Afterschool Program involves physical activity, including Brazilian Jiu-Jitsu and Muay Thai training. I accept the inherent risks, including but not limited to, injuries such as sprains, bruises, fractures, or other unforeseen incidents.
I release, waive, and discharge Ryze Martial Arts Fitness Academy, its owners, instructors, employees, and affiliates from any and all liability, claims, or damages related to my child’s participation in this program.
I further acknowledge that Ryze Martial Arts Fitness Academy is not responsible for lost, stolen, or damaged personal belongings.
6. Medical Authorization
In the event of a medical emergency, I authorize Ryze Martial Arts Fitness Academy staff to seek emergency medical care for my child if I or my emergency contact cannot be reached. I accept full financial responsibility for any necessary medical treatment.
? Does your child have any medical conditions, allergies, or medications we should be aware of?
(If Yes, please list below or attach a separate sheet)
7. Photo & Video Release
I authorize Ryze Martial Arts Fitness Academy to take photographs and video recordings of my child during training and activities. These may be used for promotional materials, social media, or marketing purposes. I understand that no compensation will be provided for the use of these images.
? Opt-Out: If you do not consent to your child's images being used, please check the box below:
☐ I do not give permission for my child's photos/videos to be used for promotional purposes.
8. Agreement & Acknowledgment
I have read and understood the terms of this agreement. I agree to abide by all policies, including the pickup policy, late pickup fees, liability waiver, and photo release.
? By signing below, I confirm that all information provided is accurate, and I accept the terms of this waiver.
Parent/Guardian Signature:
Date: {sign_date}
Initials:
