Registration
Content
Student Name: ________________________ Date of Birth: _________________ Age: ______ Parent/Legal Guardian Name: ____________________________________________________ Address: _____________________________City: ______________Zip Code: _____________ Home #: __________________Cell #: _________________Work #: _____________________ Email: _______________________________________________________________________ Emergency contact name and telephone#: ___________________________________________ Persons authorized to pick up your children, include relationship & phone number: 1. 2. _________________________________________________ phone#: ________________ _________________________________________________ phone#: ________________
Additional Information:_________________________________________________________ Office entry only: Class Time: ____________________________ Days: ________________________________ Height: ______________ Weight: ______________ Uniform size: ____________________
SCREAMING EAGLES MARTIAL ARTS www.screamingeaglesmartialarts.weebly.com 100 Executive Center Blvd., El Paso, Texas 79902 (915) 820-0739 [email protected]
PARTICIPATION RELEASE We the undersigned parents of _______________________________ permit the above named student to participate in the programs, events, demonstrations and camps offered by Screaming Eagles Martial Arts. In and for consideration of the granting of permission for said student to participate in this program and of the benefits to be derived, therefore we hereby assume full responsibility for said student’s personal safety and release Screaming Eagles Martial Arts, Eric Smith and instructors who will be participating in the program from all liabilities that may occur by reason of any injury to said student that may arise. Therefore, we agree to hold Screaming Eagles Martial Arts, Eric Smith and instructors harmless from all claims that may arise from any injury that may occur to said student by reason of said students participation, and the risks involved in respect to such a program are fully understood. I understand that this Waiver and Release form is binding as to my family members, heirs and executors. In case of a medical emergency, accident or illness, Screaming Eagles Martial Arts has my permission to secure medical attention as deemed necessary. I understand that I am responsible for any expenses associated with such treatment. I understand that every effort will be made to contact me or the person designated by me as soon as possible after such an occurrence. I acknowledge that I will read and become familiar with the program information, and I agree to abide by the terms and requirements described therein. I further agree that if I do not understand any portion of the material, I will ask for further clarification. Release for Media and Promotional Photographs / Interviews I give permission for myself, my son/daughter to be photographed or interviewed by the local media and also to take promotional pictures of my child or myself during Screaming Eagles Martial Arts activities and presentations and use them for advertising purposes. I have read and agree with the above:
Print Full Name: _____________________________ Parent/Legal Guardian
Signature: _________________________________ Parent/Legal Guardian
SCREAMING EAGLES MARTIAL ARTS www.screamingeaglesmartialarts.weebly.com 100 Executive Center Blvd., El Paso, Texas 79902, (915) 820-0739 [email protected]
Screaming Eagles Martial Arts Insurance Carrier:
915-778-5463
Additional Information:_________________________________________________________ Office entry only: Class Time: ____________________________ Days: ________________________________ Height: ______________ Weight: ______________ Uniform size: ____________________
SCREAMING EAGLES MARTIAL ARTS www.screamingeaglesmartialarts.weebly.com 100 Executive Center Blvd., El Paso, Texas 79902 (915) 820-0739 [email protected]
PARTICIPATION RELEASE We the undersigned parents of _______________________________ permit the above named student to participate in the programs, events, demonstrations and camps offered by Screaming Eagles Martial Arts. In and for consideration of the granting of permission for said student to participate in this program and of the benefits to be derived, therefore we hereby assume full responsibility for said student’s personal safety and release Screaming Eagles Martial Arts, Eric Smith and instructors who will be participating in the program from all liabilities that may occur by reason of any injury to said student that may arise. Therefore, we agree to hold Screaming Eagles Martial Arts, Eric Smith and instructors harmless from all claims that may arise from any injury that may occur to said student by reason of said students participation, and the risks involved in respect to such a program are fully understood. I understand that this Waiver and Release form is binding as to my family members, heirs and executors. In case of a medical emergency, accident or illness, Screaming Eagles Martial Arts has my permission to secure medical attention as deemed necessary. I understand that I am responsible for any expenses associated with such treatment. I understand that every effort will be made to contact me or the person designated by me as soon as possible after such an occurrence. I acknowledge that I will read and become familiar with the program information, and I agree to abide by the terms and requirements described therein. I further agree that if I do not understand any portion of the material, I will ask for further clarification. Release for Media and Promotional Photographs / Interviews I give permission for myself, my son/daughter to be photographed or interviewed by the local media and also to take promotional pictures of my child or myself during Screaming Eagles Martial Arts activities and presentations and use them for advertising purposes. I have read and agree with the above:
Print Full Name: _____________________________ Parent/Legal Guardian
Signature: _________________________________ Parent/Legal Guardian
SCREAMING EAGLES MARTIAL ARTS www.screamingeaglesmartialarts.weebly.com 100 Executive Center Blvd., El Paso, Texas 79902, (915) 820-0739 [email protected]
Screaming Eagles Martial Arts Insurance Carrier:
915-778-5463
