Self Defense Seminar Registration

Located:

Masjid An-Noor

745 Heim Rd. Getzville, NY 14068
716-568-1013

Friday, December 1st

Welcome, parents!

We’re so glad your daughter will be joining our Self-Defense Seminar, taught by our World Class team of Masters & Black Belts. We know that you want to do everything you can to keep your daughter safe, and this seminar is a great way to give them the skills and confidence they need to protect themselves.

In this seminar, your daughter will learn:

How to identify and avoid dangerous situations
Basic self-defense techniques
How to stay calm and assertive under pressure

We look forward to seeing everyone at the seminar. Parents MUST complete a waiver prior to their child participating in the class.

Self Defense Seminar Registration & Waiver

Child's Name:*
First Last
Parent/Guardian Name:*
First Last
Parent/Guardian E-mail:*
Cell Phone Number:*
Child's Birthday (mm/dd/yyyy):*
MM slash DD slash YYYY
Would you like our instructors to contact you regarding a free trial membership at our center for your daughter?*
- Yes
- No
If yes, when is the best time to contact you?*
Acknowledgement of Risk and Release of Reliability*
I am the Parent/Guardian of the Minor and am executing this waiver on behalf of the Minor in my capacity as Parent/Guardian and with the intent that this waiver be binding on me and the Minor for all legal purposes.
Parent represents that the Minor is in good health and has no disability, impairment, medical condition, illness, or health related issue which may prevent him or her from participating in Self Defense instruction, training, and/or using equipment. Parent has been informed of, understands, and is aware that any athletic program and the use of exercise equipment is a potentially hazardous activity. Parent has also been informed of, understands, and is aware that any athletic activities involve a risk of injury, serious disability, or death, and that the Minor is voluntarily participating in these activities and using equipment with full knowledge, understanding, and appreciation of the dangers involved with Parent permission. Parent hereby knowingly and freely assumes all risk and responsibility for any and all bodily and/or personal injury, including death, in connection with use of participation in Self Defense instruction, training, and/or use of equipment for thier Minor child. Parent has been advised that an examination by a medical doctor should be obtained prior to commencing an athletic program, or initiating a substantial change in the amount of regular physical activity performed. If Parent has chosen not to obtain a medical doctor’s consent for their Minor child, Parent hereby agrees that he or she is doing so solely at his or her own risk. The provisions of this section will continue in full force and effect even after termination of this Agreement.