Rape Aggression Defense Course Participant Registration Form

Rape Aggression Defense Course Participant Registration Form

Open to all female presenting students and staff at SUNY Geneseo over the age of 18. Sundays October 5th, 12th, 19th, and 26th 3:30 PM - 6:30 PM Classes are cumulative. Please plan on attending all 4 sessions. Where: Schrader Dance Studio Rm 152 NO EXPERIENCE NECESSARY! Wear athletic clothing, sneakers, and bring a water bottle. Hosted by NYS University Police.
- Participant Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Age
  Must be at least 18 years old
- Campus E-mail
  example@example.com
- Phone Number
- Local or Campus Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Do you have any self-defense or martial arts experience?
- If so, what discipline and how many years?
- Medical Problems/ Allergies
- Name
  
  First NameLast Name
- Relationship
- Mobile Phone
  Format: (000) 000-0000.
- Home Phone
  Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Liability Waiver...
  
  I hereby agree and acknowledge:
  
  a) I have been advised that the Rape Aggression Defense Course is taught using precautions to avoid any injuries. However, participation in the classes carries with it certain inherent risks and dangers that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks range from minor injuries such as scratches, bruises, and sprains, to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, to catastrophic injuries including paralysis and death.
  
  b) The practice of Rape Aggression Defense presents a risk of skin infections, MRSA, transmissible diseases, bacteria, and viruses, including, but not limited to, COVID-19.
  
  c) I shall not attend Rape Aggression Defense classes if I am diagnosed with COVID-19 or if I am in close contact with someone diagnosed with COVID-19. Further, if I am displaying symptoms of COVID-19, or if I am in close contact with someone who is displaying symptoms of COVID-19, I shall not attend Rape Aggression Defense classes. Symptoms of COVID-19 can range from mild illness to pneumonia, including fever, respiratory symptoms such as coughing, sore throat, and/or shortness of breath, and other symptoms such as a runny nose, headache, muscle or joint pains, nausea, diarrhea, vomiting, loss of sense of smell, altered sense of taste, loss of appetite, and fatigue. If I am displaying these symptoms when in attendance at Rape Aggression Defense classes, I acknowledge that I may be asked to leave.
  
  d) I shall not attend Rape Aggression Defense classes if I have any skin infection or any other communicable disease. I understand that attendance under those circumstances would constitute an undue risk to fellow participants.
  
  e) Along with the possibility of personal injury, injury to property is also possible, including but not limited to, possible loss of wages and the ability to earn such wages.
  
  f) I acknowledge that I have consulted with a physician and I have no health problems that would preclude me from full and safe participation in Rape Aggression Defense classes.
  
  g) With full knowledge and understanding of the aforementioned risks, both to myself and to my property, and after having these dangers fully explained to myself and/or to my legal guardian (Legal Guardian identified herein if the student is under the age of 18), I nevertheless desire to participate in Rape Aggression Defense training and activities.
  
  h) Due to the nature of the activities conducted in Rape Agggression Defense classes, it would be unreasonable for Rape Aggression Defense Systems, Inc. and/or the respective owners, directors and shareholders, agents and employees to be in any way responsible for my injury (or death) and to the full extent of the law I hereby waive my legal rights of action against and fully release the company for loss, damages, injury or death however arising out of or in relation to my participation in the activities conducted or organized by the company including, without limitation, liability for any negligent or tortious act or omission, breach of duty, breach of contract or breach of statutory duty on the part of the company, its office bearers, directors, employees or agents.
  
  i) I have and will maintain appropriate medical insurance during classes/training. I authorize any emergency first aid, CPR, AEDs, medication, medical treatment, and/or emergency transportation, and I assume all costs involved in such treatment.
  
  j) I will not video record or photograph any classes/training.
  
  k) I agree that if any term of this agreement is to any extent illegal, otherwise invalid, or incapable of being enforced, all other terms shall remain in full force and effect. I understand that this agreement supersedes any and all previous oral or written agreements with regard to the practice of Rape Aggression Defense, and I give up substantial rights by signing it.
- Liability Waiver
- Should be Empty: