SELF DEFENSE AMERICA


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  (936)591-8551




JIU-JITSU SEMINAR

WHEN; Saturday March 9 , 2013

TIME: 10:00-12:00 PM

WHERE: Self Defense America

                109 1/2 Shelbyville St.

                Center, TX 75935

PLEASE READ AND SIGN BELOW

LIABILITY WAIVER: I the undersigned, in consideration for the acceptance of my entry and admittance into the undersigned Camp, do hereby release and forever discharge Self Defense America (SDA), its staff, instructors and assistants, the promoters, directors, volunteers and everybody associated with the Camp and aforementioned groups from, all injuries and damages I/My Child might suffer or incur during the Camp. I assume all responsibility and risks for my entry to the Camp and so hereby state that I am physically able to participate in the Martial Art Boot Camp, and have not heretofore been advised by a physician and/or medical authority against activity of this type. I voluntarily agree to comply with all terms, conditions, and rules for participation, and certify the above information is true, to the best of my knowledge. If the above named is a minor and I have signed below as a Guardian or Parent of said minor, and have acknowledged that the waivers, release and affirmations stated above apply to said minor.

ACKNOWLEDMENT OF CONSENT: I acknowledge that SDA may use and compile photographs and video of the individual named above. I consent to such uses and waive all right to compensation. (If is a foster child there will be no photos or videos published of said minor.)

 

Pre-regristration is $25.00 after the 8th it is $40.00

 

 


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