Group Dispatch Training Registration Form

Group Dispatch Training Registration Form 2023
Class Participant Info
Name*

First NameLast Name
e-mail*
Primary Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
New or Returning Student?*

Returning StudentNew Student
Course Selection*
When we receive your registration form, we will contact you and send you an invoice via email. Payment is required to secure your place in our training class.

Please be advised that our training classes are limited.
Comments( If applicable)
Terms and Conditions
Today's Date

MonthDayYear
Date
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above participant(s), agree to release "Blue Scorpion Carrier Services", including instructors and assistants, from liability for any and all injuries which may occur while training, practicing, performing, or during any studio event or activity. You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your student(s) at your expense should the need arise. You also give your permission for the public display of any training/class visual images that you the participant of our training may appear in.
I Agree
Please Upload Your ID or License*

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Group Dispatch Training Registration Form 2023