Consultation Form

Student Information

First name

Last name

Birthday

Month

Day

Year

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Parent/Guardian Spouse Information

Name

Relationship

Phone

Name

Relationship

Phone

RELEASE AND WAIVER RELIABILITY

I, the undersigned hereby waive all claims against any and all persons associated with the BEEHIVE FIGHT CLUB LLC.. I understand that I am participating in a martial art which has body contact. I understand that this form of martial arts involves choke holds, arm locks, neck cranks, ankle locks, throws, slams, punches, kicks, elbows, knees, and such which could potentially cause serious injury or even death. I assume full responsibility for all my actions during and connected to the above organization. I understand the risk of participating in this form of martial arts training and hereby release the BEEHIVE FIGHT CLUB LLC and all of its agents, employees and associates of and from any and all liability, claims, demands, actions, medical bills, and causes of action whatsoever arising out of or relating to any negligent or other act or omission, and/or any loss, damage, or injury, including death, that may be sustained by the undersigned or any property of the undersigned in participating in this form of training. I, the undersigned also state that I am in good physical condition and know of no reason why I can not train in this form of training. I understand that in case of emergency, I hereby authorize any licensed medical personnel to perform any accepted medical assistance deemed necessary and I agree to bear the expense of any such treatment. As additional consideration for training at BEEHIVE FIGHT CLUB LLC, I agree that my attendance and/or performance at the academy and abroad at events and such may be photographed, filmed and/or taped and used by the BEEHIVE FIGHT CLUB LLC for marketing purposes and I authorize the use of my image and I waive any compensation thereof – even if I discontinue my training at the BEEHIVE FIGHT CLUB LLC. I acknowledge that I would like to receive correspondence from the academy via telephone, mail, and email. I, the undersigned, being duly aware of the risks and hazards inherent upon participating in this form of martial arts agree to all its rules, terms, and conditions. I acknowledge that I fully understand the BEEHIVE FIGHT CLUB LLC rules and sparring rules, have been told of them, understand them, and agree to honor and obey them. I understand that disobeying the rules may, at the instructor’s discretion, result in suspension or expulsion from BEEHIVE FIGHT CLUB LLC and that I will not be entitled to a refund and if expelled must pay the remainder of my contract if one has been signed. In signing the foregoing release, the undersigned hereby acknowledges and represents: that he/she has read the foregoing release, understands it and signs it voluntarily; that he/she is over 18 years of age and of sound mind. If under 18, parent/legal guardian in signing this release agrees to all its terms and conditions.

Name

Signature

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Membership Agreement

Member Information

First name

Last name

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

$150 month to month membership with a minimum of 3 months.

CREDIT CARD TYPE

VISA

MASTER CARD

AMEX

DISCOVER

NAME ON THE CARD

CREDIT CARD NUMBER

EXP DATE MM/YY

BILLING ZIP CODE

ELECTRONIC DRAFT PAYMENT

NAME ON THE ACCOUNT

NAME OF BANK

NAME OF BANK BRANCH

Multi-line address

Country/Region

Address

City

Zip / Postal code

CHECKING TRANSIT/ABA #

ACCOUNT NUMBER

I have reviewed and agree to the terms and conditions listed on the form of this document. I agree to pay the membership as listed in the above section (Member Information). Should the participant be less than 18 years of age I, the signatory below agree to the terms and conditions listed on this document and take full responsibility for the payment of this membership.

Print Name

Signature

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General Terms: This document represents an Agreement between the participant referenced on the front side of this document and Beehive

Fight Club LLC. This agreement is nontransferable among other parties, relatives, etc. Monies paid to BEEHIVE FIGHT CLUB LLC are non-

refundable. Once a participant has enrolled in a program and begins a new month, the participant is responsible for dues the next month.

These dues are to be paid as outlined on the front side of this document.

Late Fee: For EFT accounts, if applicable, a late fee of $25.00 will be assessed for any payments made after 5 calendar days from when the

participants payment due date. The Fee as well as any membership dues under this agreement is non-refundable.

Contract Early Cancellation Fee: Memberships cancelled prematurely before the said due term date are subject to an early Cancellation Fee,

which is proposed of but not limited to 50% of the remaining balance due forward from the term contract. Any duration of time a membership

is suspended or frozen may not count towards fulfillment of time associated with the terms of the contract or early cancellation fee.

EFT Open Ended Benefit: All EFT memberships are subject to the EFT open Ended Benefit. When a term membership or minimum time

membership fulfills its required time, the membership will continue to be active as a month to month account. At the end of said membership

term, the student is eligible for 30 days of membership free of charge. The membership will roll over to a month to month membership while

maintaining its current tuition rate without an increase to the current month to month tuition rates. I do hereby understand this benefit and

further understand that if I wish to cancel my membership and discontinue the Open Ended Benefit; I must do so in writing, and I understand

that it is not BEEHIVE FIGHT CLUB’s responsibility to discontinue my benefit without my written consent or request.

Membership Obligation & Termination: BEEHIVE FIGHT CLUB LLC. does hold its members to their chosen contractual obligations. BEEHIVE

FIGHT CLUB LLC. members are able to cancel at any time AFTER (3) MONTHS FROM DATE OF ENROLLMENT provided the following conditions are met. Cancellation requests must be received in person and/or sent via mail. In order to protect your rights and to provide you with a record of your Cancelation Request, your request should be sent using a method which generates a tracking record of your mailed Cancelation Request (i.e. USPS Certified Mail, Mail Courier, etc.) BEEHIVE FIGHT CLUB LLC will not reimburse you for any costs incurred to send Cancellation Requests. BEEHIVE FIGHT CLUB LLC. is not responsible for failure to terminate any memberships as a result of non-receipt of sent Cancellation Requests or should the Cancelation Requests be sent using any other method than that previously mentioned. In addition to proper service of the Cancellation Request, the Cancellation Fee; if applicable; must be paid in full at time of cancellation in order to process the cancellation.

Pursuant to Physical Fitness Service Act, you are notified as follows:

Contract requirements; cancellation and refund.

(a) Every contract for physical fitness shall provide that: (1) the contract maybe be cancelled by the customers within 3 business days after the first business day after the contract is signed by the customer, and that all monies paid pursuant to the said contract shall be refunded less $60.00 processing fees and uniform charge. For the purposes of this Section, business day shall mean any day on which the facility is open for business. A customer purchasing a plan at facility which has not yet opened for business at that time the contract is, or who does not purchase a contract at an existing facility shall have seven calendar days in which to cancel the contract and receive a full refund of all monies paid. The customer’s rights to cancel the contract described herein are n addition to any other contract rights or remedies as provided by law; (2) In the event of the relocation of a customer’s residence to farther than 25 miles from the center’s facilities , and upon the failure of the original center to designate a center with comparable facilities and services within 25 miles of the customer’s new residence, which agrees to accept the original center’s obligation under the contact and shall be liable for only that portion of the charges allocable to the time reasonable evidence of such relocation is presented to the center plus a reasonable fee if so provided in the contract but such feel shall not exceed 10% of the unused balance or $50.00 whichever is less; and if the customer because of death or disability, is unable to use or receive all services contracted for, the customer, or his estate as the case may be, shall be liable only for that portion of the damages allocable to the time prior to death or onset of disability. The center shall in such event have the right to require and verify reasonable evidence of such death and disability.

(b) Every contract for physical fitness services shall provide that notice of cancellation pursuant to subsection (a) certified of this Section certified or registered mail to the center at the address specified in this contract. All refund to which a customer or his estate s entitled to shall be made within 30 days of this receipt by the center of this cancellation notice.

Property Damage: The participant may be held liable for any damage incurred to any property belonging to BEEHIVE FIGHT CLUB LLC. or any of its members if it is deemed that any property damage was caused to negligence of the participant. The participant will be held responsible for

all costs to repair or replace said property. BEEHIVE FIGHT CLUB LLC. will make every reasonable attempt to repair any damaged property. In

the vent this is not possible, the participant will be required to purchase a replacement for the damaged property within 14 calendar days of

notification. Notification will be sent to the participant’s address of record on the front side of this agreement. BEEHIVE FIGHT CLUB LLC. is not

responsible for any notices which are not received by the participant as a result of falsified record or contact information.

The BEEHIVE FIGHT CLUB Pledge to Students: BEEHIVE FIGHT CLUB LLC. will use its best efforts to assist the student in obtaining his or her

maximum potential in the Martial Arts. BEEHIVE FIGHT CLUB LLC. is committed to providing and maintaining professional facilities, staff and a

varied class schedule. The student understands that BEEHIVE FIGHT CLUB LLC. is providing a service where two way communication is essential to the effective servicing of the student, agrees to communicate his/her needs and/or problems.

Membership Agreement: BEEHIVE FIGHT CLUB LLC. agrees to provide the student with lessons in the Martial Arts on a scheduled established

basis established by BEEHIVE FIGHT CLUB LLC., each lesson to be at least forty-five minutes in duration. Lessons scheduled may be modified at

the discretion of BEEHIVE FIGHT CLUB LLC. from the time to time for holidays, Martial Arts tournaments and other BEEHIVE FIGHT CLUB LLC.

activates. BEEHIVE FIGHT CLUB LLC. shall give prior notice of such modifications by general announcement.

Without prior request from the student, and without prior written approval of BEEHIVE FIGHT CLUB LLC., no deviation of the established class

may be made by the student, and the failure of the student to attend any scheduled lesson shall terminate his or her rights to that lesson only.

The student recognizes that the class attendance is important for the student’s progress and understands that it is the student’s responsibility

to attend the classes. It is further understood that the student is obligated to make payments whether or not the student attends classes. The student further understands that failure to complete the lessons does not relieve the student of the obligation to pay the tuition in full.

The student understands further that strict observation of the rules and regulations relative to training include the use of protective equipment

required by the schools. The equipment will largely eliminate the possibility of accident or injury; however BEEHIVE FIGHT CLUB LLC. does not warranty the protective equipment. The student further agrees to waive any claim of damages against the academy and/or its principals or its instructors in any case resulting from the activity. The names of the students and any photographs or motion pictures taken during BEEHIVE

FIGHT CLUB LLC. activities are property of BEEHIVE FIGHT CLUB.

The party agrees that the cost for uniforms, test fees, tournament fees, protective equipments, and other BEEHIVE FIGHT CLUB related

activities are not covered by this document and remain the responsibility of the student. The BEEFIGHT FIGHT CLUB student agrees that he/shill

will refrain from using the knowledge obtained from BEEHIVE FIGHT CLUB in any capacity without compensation. Students most not work in or

own a school for a distance of no less than 20 miles in all directions from BEEHIVE FIGHT CLUB. BEEHIVE FIGHT CLUB LLC. reserves the right to display any trophy, medal, etc. won by any student for a period of one year. Official recognition will be issued to the student by BEEHIVE FIGHT CLUB upon the successful completion of any examinations and the requirements thereof.

This agreement in non-transferable without the expressed written consent of BEEHIVE FIGHT CLUB.