Teen Life Skills: "Self-Defense Basics"
Waiver of Liability and Parent / Participant Responsibility Agreement
Teen Participant's Name:
*
First Name
Last Name
Teen Participant's Age:
*
Please Select
14
15
16
17
18
For the safety of all participants, this program is strictly for teens ages 14 - 18 ONLY.
Teen's Email Address:
*
We will email your certificate of participation to this address - this is what verifies your service credit!
Name of Parent / Legal Guardian:
*
First Name
Last Name
Parent / Legal Guardian's Email Address:
*
example@example.com
Parent / Legal Guardian's Cell Phone Number:
*
Please enter a valid phone number.
Parent / Legal Guardian Signature
*
Submit
Should be Empty: