Registration ‹ New Amsterdam Fencing Academy North

Email*

Password*

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Personal Information

Participant's Name*

First Last

Birth Date*

Home Phone*

Cell Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Waiver of Liability and Release

Upon entering this program under the auspices of NAFA and the USFA, I agree to abide by proscribed rules of conduct and safety.

Students enter NAFA’s program at their own responsibility, and at their own risk. Each participant, by accepting the terms of enrollment, must accept full responsibility for his/her own safety, and must agree to absolve NAFA, its coaches and its employees, from liability for such accidents as may occur.

I grant permission to New Amsterdam Fencing Academy and its agents or employees, to use photographs taken of me or my child in class, camp or other activities within its premises for use in publications such as brochures, newsletters, and magazines, and to use the photographs on display boards, and to use such photographs in electronic versions of the same publications or on web sites or other electronic form or media, without notifying me.

Participant's Signature*

Signature of Parent or Guardian*

Name of Parent or Guardian*

In case of Emergency

Please provide a contact name and phone number for use in the event of a medical emergency.

Contacts*

Name	Phone

Consent for Medical Treatment

This is to certify that on this date I, the undersigned participant or legal guardian, give my consent to NAFA, and its representatives, to obtain medical care from any licensed physician, hospital or clinic for the above named student, for any injury or illness that may arise during activities associated with NAFA’s courses and club activities.

Signature*

Registration

Signup

Personal Information

Waiver of Liability and Release

In case of Emergency

Consent for Medical Treatment