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Please type or print all information. First Name_________________________Last Name___________________________M.I.______ Mailing Address_________________________________________________________________ City_______________________________________State____________Zip_________________ Phone (_____)______________ Fax (_____)_____________ Email___________________________________ Birth Date_______/_______/________ Gender (M/F) ____ Years Fencing_____
Fees
$125.00 Pre-registration
$150.00 at the door
Please make your check or money order payable to the Martinez Academy of Arms. Registration should be post marked by August 6th at the latest to insure that they arrive in time.
We are not responsible for lost or misdirected mail. Cancellations must be received by August 2nd, 2005 in order to receive a refund. No refunds will be made after August 2nd, unless the workshop is cancelled due to inclement weather.
Please indicate what weapons you have.
Rapier____ Smallsword______ Sabre____ Walking stick_______ Navaja______
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 registered. Participants must be 18 years of age and over.
Waiver of Liability
By signing below, the participant agrees to abide by all rules as stated by the organizers and instructors (hereafter collectively referred to as “Spanish Martial Arts Weekend Seminar officials”) affiliated with the Martinez Academy of Arms (hereafter “MAA”).
The participants in the Spanish Martial Arts Weekend agree to participate in the training classes, exercises and drills and may engage in fencing exclusively under the supervision of the MAA officials and accept the decisions of those 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 Spanish Martial Arts Weekend will result in expulsion from the seminar without refund.
Jeannette Acosta-Martinez
Phone 201-330-8670
Email email
Martinez Academy of Arms
PO Box 2013
Secaucus, NJ 07094-2013
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 seminar hosted by MAA. 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 MAA 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 seminar 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 Spanish Martial Arts Weekend seminar 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 Martinez Academy of Arms, 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 of the seminars activities. I hereby agree and covenant not to make a claim against, sue or attach the property of any affiliated organizations or aforementioned parties.
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 SPANISH MARTIAL ARTS WEEKEND SEMINAR BEING AWARE OF THE RISKS AND CONDITIONS INVOLVED AND DO SO OF MY OWN FREE WILL.
Participant: ______________________________ Date:________ Signature:_____________________________________________Mail this completed application with payment to:
Martinez Academy of Arms
PO Box 2013
Secaucus, NJ 07094-2013
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Webmaster: Kim Moser (email) |
