Escape Alive Survival Skills Class Registration

Each person wishing to attend a class must complete this form.

All participants 17 years of age or younger must have a parent or guardian digitally sign this form.
Name of person attending the class*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number
What is the venue/location of class you wish to register for?*
Click here to view the list of our upcoming classes.
How did you hear about this event?*

Company/SponsorEnewsletterFlyerFriend/FamilyPrint MediaRadioSocial MediaVoice2Change PodcastWebsiteOther
Name of company/sponsor*
Name of friend/family member*

First NameLast Name
I am between 12 and 17 years of age*

YesNo
Parent/Guardian Name*
Parent/ Guardian Signature*

Clear
Signature*

Clear
Please note that while the instructors will be notified that you have opted out of having any photos or videos taken of you and/or your child during the class you indicated, YOU MUST inform the instructors of East Coast Training Systems prior to the start of the class so that they are aware of your preference. You will also be required to sign a waiver and anyone under the age of 18 must have a parent/guardian sign the waiver on their behalf at the time of entry.
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