Registration
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Waiver for NSC
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
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Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Additional Information:
Assumption of Risk
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I acknowledge and understand the potential risk of injury and dangers inherent in the sport of obstacle training and other athletic activities sponsored by Stamford Ninja Academy, and I acknowledge the assumption of those risks.
I allow Stamford Ninja Academy to use pictures and video of myself or my child in social media posts. Names will not be posted. I also understand that even the act of taking pictures or video of my birthday child on the gym floor presents a risk and I acknowledge the assumption of those risks. Professional ninjas' likeness will NOT be used in marketing.
I've read the above and agree.
Release of Liability
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For and in consideration of athlete's registration with Stamford Ninja Academy, I as an athlete or as an athlete's parent and/or legal guardian hereby release forever discharge covenant not to sue and agree to indemnify and hold harmless Stamford Ninja Academy, its owners and employees, from any and all liabilities, claims, demands or causes of action that I may hereinafter have for injuries or damages arising out of participation in activities at Stamford Ninja Academy, or events which it may sponsor or be affiliated with or activities incidental thereto. This release includes but is not limited to injuries, damages or losses caused by the passive or active negligence of the released parties or hidden, latent or obvious defects with the equipment sold or used, and includes parents who may be on the gym floor to take pictures or video of their birthday child.
I've read the above and agree.
Enter your Full Name:
*
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