Midwest Martial Arts and Gracie Jiu-Jitsu Academy®
7721 W 151st Overland Park, Kansas 66223
Phone 913 681-1777 website: www.midwestmartialartsacademy.com
mmaakicksite@gmail.com
Parent or Guardian:
LIABILITY WAIVER
I consider myself and/or my child to be in good health or have medical approval to engage in Tae Kwon Do \ Hap Ki Do\ Jiu-Jitsu training. I further absolve the Academy’s Instructors and anyone directly or indirectly involved from any liability and assumes all risks associated with and incidental to this training program.
AUTHORIZATION
Electronic Funds Transfer Authorization: By completing and signing this Electronic Funds Transfer Form, I authorize Midwest Martial Arts Academy to initiate a monthly debit entry to my account at the financial institution listed above in order to pay my monthly licensing fee. I understand that the designated bank account will be debited monthly, on approximately the first day of the month. This authorization will remain in effect until Midwest Martial Arts Academy has received a completed discontinuation notification as described below. Midwest Martial Arts Academy reserves the right to void this form at anytime without notice. Non-payment of the licensing fee will result in termination of your licensing privileges.
***To qualify for promotion with Gracie University you must have 8 consecutive months of training as a CTC member.
Change/Discontinuation: Any change to your banking information or discontinuation of service request should be received by Midwest Martial Arts Academy thirty days prior to the effective date of change. Please be advised that if Midwest Martial Arts Academy receives your notification to discontinue electronic funds transfer less than 30 days in advance, your bank account will be debited for the upcoming monthly licensing fee. If discontinuation happens before 12 months there will be a $50.00 charge. Any change to your banking information or request to discontinue service must be done so in writing and delivered to Midwest Martial Arts Academy at 7721 W 151st., Overland Park, Ks. 66223 or to mmaakicksite@gmail.com.