Registration
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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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DE
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IA
ID
IL
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NJ
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OR
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Zip:
*
Emergency Phone # & name
*
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:
Release of Liability
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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 Hamden Ninja Academy., and I acknowledge the assumption of those risks. I also acknowledge the risk of being inside the gym area to take pictures or video during the party.
I allow Hamden Ninja Academy., to use pictures and video of myself and my child in social media posts. Names will not be posted.
I've read the above and agree.
Assumption of Risk
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For and in consideration of athlete's registration with Hamden 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 Hamden 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 Hamden 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.
I've read the above and agree.
Participant
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All participants at parties must be 5 by the day of the party or event and not more than 14.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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