Bagels & Bullets Registration Form

Bagels & Bullets Registration Form
Date of Form Completion*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Consent to participate

Please inform us of any and all injuries, physical limitations or special needs of all participats prior to session registration.

By participating in this activity, you are accepting the risk of an accident occurring, and agree that this activity, is suitable for you.
Preferred payment*

Zelle - send to ChaiDefense@gmail.comCredit card - a link will be provided after submission
Signature: By providing my signature, I acknowledge that I have read, understand, and agree to the policies and procedures of the Chai Defense and Guns N Moses NJ Release Waiver attached herein. *

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