Thursday Night Defense and Empowerment Class

Youtube

Learn concepts and strategies to recognize potentially dangerous situations and behaviors and avoid them before they become a danger to you as well as the physical skills you need to escape an assailant.

Hosted By: Ma'am Cheryl Sanders and Master Jonathan Field, the Founders of EMPOWERED

Who's This For?: Ladie and Teen Girls

When: Thursday, December 9th and Thursday, December 16th from 6:15pm to 7:00pm

Where: Cobourg Tae Kwon Do, 271 Spring St., Cobourg ON K9A 3K3 905-373-0032

What You Will Learn:

Thursday, Dec 9th (Night 1) - Concepts and Strategies to help you make smarter decisions in your daily lives to help you avoid potentially dangerous situations, as well as recognize them before they can happen. You will also learn how to use the various natural weapons you have on your body and where to strike an assailant.

Thursday, Dec 16th (Night 2) - You will put together the concepts, strategies, and physical tools, and learn how to apply them to various situations and common attacks you may encounter.

COVID-19 Protocols are in place to keep everyone safe and healthy. Under our government mandate, participants must wear a mask while entering the building but once in our main training area, masks do not have to be worn. Proof of vaccination must also be shown. Thanks for your understanding.

PLEASE FILL OUT THE FORM BELOW TO REGISTER

Name (First Participant)

First NameLast Name

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Name (Second Participant)

First NameLast Name

Date of Birth

Date

Address (Leave Blank if Same Household as First Participant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Name (Third Participant)

First NameLast Name

Date of Birth

Date

Address (Leave Blank if Same Household as First Participant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Name (Fourth Participant)

First NameLast Name

Date of Birth

Date

Address (Leave Blank if Same Household as First Participant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Please Select Number of Participants

Participants

$25.00CAD Quantity
Item subtotal:$0.00CAD

Total

$0.00CAD

Informed Consent and Acknowledgement I hereby give my approval for myself or my child’s participation in any and all activities prepared by Empowered during the selected workshop or class. In exchange for the acceptance of said child’s candidacy by Empowered ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Empowered . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Empowered . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization As Parent and/or Guardian of the named child or myself, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child or myself, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Empowered . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

COVID 19 Acceptance of Risk

Empowered release of liability, waiver of claims, assumption of risk and indemnity agreement in relation to COVID-19 and other similar infectious diseases. By signing this release agreement, you will waive or give up certain legal rights, including right to sue or claim compensation following exposure to COVID-19 or related viruses and illness and death as result. PLEASE READ CAREFULLY.

I understand that the World Health Organization has classified the COVID-19 outbreak as a pandemic. I further understand that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may resulting significant personal injury or death.

I understand and accept that while Empowered has undertaken the required steps as indicated by the department of public health to lessen the risk of transmission of COVID-19 in connection with the programs and services the Empowered is not responsible in any manner for any risks related to COVID-19.

I agree to strictly comply with the COVID-19 Guidelines issued by Empowered and may be amended from time to time as further information is obtained. These Guidelines are posted at Empowered and on our website. I have read, understand, and agree to this provision.

I am fully aware and accept all risks that participation at Empowered carries with it inherent risks related to COVID-19 transmission (“Inherent Risks”) that cannot be eliminated regardless of the care taken to avoid such risks. Inherent Risks may include, but are not limited to, (1) the risk of coming into close contact with individuals or objects that may be carrying COVID-19; (2) the risk of transmitting or contracting COVID-19, directly or indirectly, to or from other individuals; and (3) injuries and complications ranging in severity from minor to catastrophic, including death, resulting directly or indirectly from COVID-19 or any treatment.

Further, I understand and accept that the risks of COVID-19 are not fully understood, and that contact with, or transmission of, COVID-19 may result in risks including but not limited to loss, personal injury, sickness, death, damage, and expense, the exact nature of which are not currently ascertainable, and all of which are to be considered Inherent Risks.

I hereby voluntarily accept and assume all risk of loss, personal injury, sickness, death, damage, and expense arising from such Inherent Risks. Furthermore, I represent and warrant that I do not suffer from any medical condition or disease that might in any way hinder or prevent me from receiving the Services, including, to my knowledge, COVID-19.

I hereby agree to contact Empowered immediately for any of the following (1) I contract COVID-19; (2) I was in contact with anyone that contracted COVID-19; I experience any of the following Flu Symptoms, Sore Throat, Vomiting, Cough, Tiredness and Fever.

I fully understand and agree to the terms and conditions identified above and I agree to follow the COVID-19 Guidelines which I have read, and which may be amended from time to time as new information is obtained. I understand that if I contravene these guidelines, I will be removed from the Empowered immediately and may be suspended from the Empowered until suitable discipline according the club Discipline Policy.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.