|
|
|
|
Name:____________________________________________________________________ Address:_________________________________________________________________ City:______________________ State:_____ Zip:________ Country: __________ Date of Birth: Month:____ Day:____ Year:______ Gender: [ ]Male [ ]Female Home Phone: (______)______-______ Work Phone: (______)______-______ Fax: (______)______-______ E-mail: ________________________________________
A minimum deposit of $200 is required with the registration. The total price for the seminar including lodging, meals and tuition is $625 if registration is postmarked by April 12 or earlier; after April 12 the cost of the seminar is $725. Payment is due in full by May 12. After May 12 no refunds of any payments or deposits will be given under any circumstances. Any payments received after the camp is full will be returned to the sender. If your registration is accepted you will receive a letter of confirmation by mail and/or email. Participants must be 16 years old and over. A parent or legal guardian must accompany participants under the age of 18.
Make your check or money order payable to Antone Blair; do not send cash.
Amount Enclosed: _______
You will need to bring your own equipment, including a practice rapier, practice dagger, 3-weapon fencing mask, jacket, cup protectors for men, breast protectors for women, and gloves at minimum. HSU may be able to provide SOME equipment, but ONLY if you contact Antone Blair to make arrangements before May 12, 2005.
Which school of rapier fence do you wish to study at this camp?
[ ] Spanish [ ] Italian
If there are particular people with whom you would like to share a room, please list them in order of preference below (this information will be kept confidential)
Roommate requests: 1 _________________ 2 _________________ 3 _________________
Requests for roommates are not guaranteed.
In the space below, briefly describe how much experience you have in historical rapier fencing:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Do you have any existing medical conditions which you feel the instructors and/or staff should be aware of?
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
You must sign the waiver of liability in order to be enrolled.
By signing below, the participant agrees to abide by all rules as stated by the organizers and instructors (hereafter collectively referred to as “the camp officials”) affiliated with the Redwood Rapier Camp (hereafter “the camp”).
The participants in the camp agree to participate in the training classes, exercises and drills and may engage in fencing exclusively under the supervision of the camp officials and accept the decisions of the camp officials. Failure to abide by these criteria or to conduct oneself in a manner respectful to the officials and other participants or those otherwise affiliated with the camp will result in expulsion from the camp without refund.
Antone Blair
Redwood Rapier Camp
1348 I Street
Arcata, CA 95521
I Hereby:
1. Understand that I have the right and duty to inspect all materials, weapons, facilities and/or equipment to be used and if I believe that anything is unsafe or beyond my capability I will immediately advise an official of such condition(s) and refuse to participate.
2. Declare that I am physically capable of participating in all activities of the camp hosted by Humbolt State University Fencing Club and Martinez Academy of Arms. If I am aware of any physical or mental limitations, which may make participation unsafe or am under treatment for any physical or psychiatric infirmity, ailment, illness, or condition, I have informed my medical provider and a representative of the camp of my participation, and my medical provider has approved my participation to me personally.
3. Agree to accept and abide by all the rules of the camp officials.
4. Acknowledge and understand that I will be voluntarily engaging in activities which involve contact and risk of serious injury, permanent disability or death and may cause sever social or economic losses due to not only my own actions, inactions or negligence but also to the action, inaction or negligence of others or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable buy myself and/or the owners/operators of the Redwood Rapier Camp at this time.
5. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.
6. Release, waive and discharge from any and all claims, demand, damage, action or causes of action of every kind and nature whatsoever that I, my assignees, heirs, guardians and legal representative now have or hereafter have for damage or losses due to injury, including but not limited to permanent disability and/or death, and/or damage to property, caused, however caused arising out of, attributable to or in any way connected to or occasioned by, in whole or partially, the negligence, carelessness or other actions or inactions of the Redwood Rapier Camp, its agents, owners, officers, directors, servants, instructors, sponsors, employees and other participants, their parents, guardian(s), supervisors, and instructors and the owners, lessors, and lessees of the premises as a result of my participation in any Redwood Rapier Camp activities. I hereby agree and covenant not to make a claim against, sue or attach the property of any affiliated organizations or aforementioned parties.
7. Parent(s) or legal guardian(s) of minor participants additionally agree to instruct the minor participant of the aforementioned warning, waivers, conditions and their ramifications and hereby consent to the minor’s participation in the Redwood Rapier Camp activities.
I HAVE CAREFULLY READ AND CONSIDERED THE ABOVE WAIVER AND RELEASE OF LIABILITY AND COMPLETELY AND FULLY UNDERSTAND EACH SECTION. I FUTHER UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING THE ABOVE DOCUMENT AND I DO SO FREELY AND VOLUNTARILY AND WITH FULL KNOWLEDGE OF THE CONSIQUENCES. I AGREE TO PARTICIPATE IN THE ACTIVITIES OF THE REDWOOD RAPIER CAMP BEING AWARE OF THE RISKS AND CONDITIONS INVOLVED AND DO SO OF MY OWN FREE WILL.
Participant: ______________________________ Date:________ Signature:_____________________________________________ Parent/Guardian:__________________________ Date:_________ Signature:_____________________________________________
Mail this completed application with payment to:
Antone Blair
Redwood Rapier Camp
1348 I Street
Arcata, CA 95521
|
Copyright © 2005 by Ramón Martínez (contact) All Rights Reserved |
Webmaster: Kim Moser (email) |
