Registration Form
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Email *
Which Capoeira Saturday class are you registering for? *
First Name *
Last Name *
Telephone
Email Address. *Please note after the class you will receive a survey to rate your experience.
May we email you information about regular classes?
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Street Address
City
State
Zip Code
Participant Age
Gender
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How would you best describe yourself? (This information is for grant purposes.) *
Preferred Pronouns
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Do you have any prior experience with capoeira?
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Do you have any medical conditions that the instructors should know? *
How did you hear about the classes? *
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM. Name of the Entity (s): American Capoeira Foundation, its administrators, and all other persons, firms, employees, guest teachers, corporations, association or partnerships.I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released. I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event. I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. *
A copy of your responses will be emailed to the address you provided.
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