Womens Self Defense Registration

Womens Self Defense Registration

After you fill out this form, you will be redirected to make payment.

Full Name

Age

Email Address

Phone Number

Number Attending

Names & ages of attendees not listed above (one per line).

How did you hear about us?

Do you have any health conditions/physical restrictions that would compromise your participation in a self defense/ martial arts/fitness program?

Yes

If yes, please list

I agree to the following waiver and release.

Waiver and Release: I fully recognize the risks of injury inherent in participation in any fitness, martial arts or self defense program. I represent to Peaceful Warrior Martial Arts & Healing Center (PWMAHC) that I have taken all reasonable steps to determine and hereby warrant that I am in good health and am physically capable of participating in the courses of instruction offered by PWMAHC. I acknowledge that PWMAHC shall neither make nor have responsibility to make any independent evaluation of my physical health or fitness. I understand and agree that all participation in any such program or use of the facilities or equipment on or off the premises shall be at my own risk. I understand this training involves physical contact and physical exercise. I am aware that I am engaging in physical exercise and self defense instruction. I have contacted my physician and I am voluntarily participating in these activities.

I hereby release, indemnify and hold harmless PWMAHC, its officers, directors, managers,
employees, instructors, contractors, volunteers and agents from and against any claims, demands, cost and liabilities of any kind or nature. This includes attorney’s fees and/or costs related to injury or death. In addition, I agree that PWMAHC shall not be responsible for the conduct of other users of the facilities, equipment or off premise activities/programs.

NOTE: When you click "Submit Registration" below, you will be redirected to make payment.

Cost is: $40