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2008 PCMA Summer Clinic Registration Form |
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READ and SIGN BELOW :
Waiver, Warning, and release of Liability. I agree that prior to participating I will inspect the mats, equipment, facilities, and notify a clinic instructor or supervisor of anything I believe is unsafe or beyond my capability and refuse to participate. I acknowledge and fully understand that Martial Arts training involves close physical contact with others and that I enter this practice and training entirely of my own free will. I acknowledge and fully understand that Martial Arts training is a physical contact exercise and that I may engage in activities that might result in serious injury and social and economic loss due to not only my own actions, inactions, or negligence, but also the action, inaction or negligence of others. I acknowledge that there may also be other risks not known to me or not reasonably foreseeable at this time. I acknowledge and assume all risks involved in the self defense and sport activities called the “Martial Arts”. I understand the importance of following rules set down by my Sensei, Coach, and all Instructors at this event. If at any time I believe the training at this clinic to be unsafe, I will refuse to participate. I certify that I am in good physical and mental condition and have no disease, injury or other condition that would impair my performance in intense physical practice and /or training. I hereby give permission, in case of injury, to have a doctor, nurse, athletic trainer, or other medical emergency personnel provide me with medical assistance and/or treatment for such injury. I release, waive, discharge and covenant not to sue my Martial Arts Instructor, his staff, Professional Combined Martial Arts, Inc. Spring Martial Arts, or any other instructor or participant involved in my training. This also includes the host, The Lone Star Convention Center, other participating schools, affiliated clubs, their administrators, directors, agents, coaches, employees, volunteers, officials, medical personnel, other participants, their parents, guardians, supervisors, coaches, and sponsoring agencies. I certify that I am the person, ( or the parent and/or legal guardian of the minor participant) for whom I am signing. I certify that, by signing, I have read this form to the minor and advised the minor of the above warning, training conditions and their ramifications, and I additionally confirm and agree to all of the above statements, waivers, and releases and agree to all of the above statements, conditions, waivers, and releases, and consent to train under the above conditions. ________________________________ |
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FEES: Clinic Fee (For Friday thru Sunday: $35.00 by 7/1/08 ($40.00 after 7/1/08 and at the door). Packets from schools with 10 or more participants receive a $5.00 discount per participant. Banquet : $22.00/ ea. Professionally catered at the clinic location. Must be paid by 7/10. No walk-ups. T-Shirt : $15.00 each (Must be ordered by 7/1/08). Available in Size Child 10/12 Adult S, M, L & XL __________________________________________ |
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Number of Participants @ $35.00 ______ = $_________ Number for Banquet @ $22.00_____ = $_________ Number of T-Shirts @ $15.00 10/12 ____ S ____ M ___ L ___ XL ____ = $_________ _____________________________________________ Make Checks Payable to: Chuck Chretien Mail to: Spring Martial Arts 24307 Aldine Westfield Rd, Ste. U. Spring, TX 77373
(Any questions, problems or concerns, please contact me at (281) 288-1616 or email me at chuck@springmartialarts.com) |
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Participants name (Printed ):_______________________________________ Art:____________ Rank______ Participants Signature __________________________________________________ Date:________________ (Parent or Guardian if less than 18 years of age) Participants name (Printed ):_______________________________________ Art:____________ Rank______ Participants Signature __________________________________________________ Date:________________ (Parent or Guardian if less than 18 years of age) Participants name (Printed ):_______________________________________ Art:____________ Rank______ Participants Signature __________________________________________________ Date:________________ (Parent or Guardian if less than 18 years of age)
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