K.E.E.P. / SedonaMoves Member Registration Form

K.E.E.P. / SedonaMoves Member Registration Form

Thank you for choosing to begin your journey with us. Please complete this membership sign-up form, which includes your member information and the required Waiver & Release of Liability. Once your registration and payment are complete, we will reach out to schedule your one-on-one private class or group class. If you have any questions at any time, please don’t hesitate to contact us — we’re here to help.
Member Information

Participant or Parent/Guardian of Participant
Your Name

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child’s Name (If applicable)*

First NameLast Name
Child's DOB

MonthDayYear
Date
Who will participate in classes?

YouYour childYou and your child
Does any of the participants have any previous Martial Arts, Combat Sports or other training background? *
Does any of the participants have any medical conditions or in juries that would prevent you from participating in full contact Martial Arts or Sports?*
What are the participants health/fitness goals? What do you hope to get out of training?*
Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Health Insurance Provider
Waiver, Release of Liability & Indemnification Agreement
Waiver, Release of Liability & Indemnification Agreement
SedonaMoves / K.E.E.P. After School Program LLC

I, the undersigned participant (or parent/guardian of a minor), acknowledge and agree as follows:

Assumption of Risk
I understand that participation in activities with SedonaMoves / K.E.E.P. After School Program LLC — including but not limited to martial arts, Brazilian Jiu-Jitsu, yoga, self-defense, fitness, movement, and mindfulness — involves inherent risks of injury, illness, or even death. I voluntarily assume all such risks for myself (or my child).

Release & Indemnification
I hereby release, indemnify, and hold harmless:

K.E.E.P. After School Program LLC,
SedonaMoves,
Olivier Barre, Margot Barre,
Their heirs, trade names, business entities associated with or under K.E.E.P. After School Program LLC or Kids Empowerment Enrichment Program,
As well as all officers, instructors, employees, agents, contractors, volunteers, affiliates, sponsors, and representatives
from any and all liability, claims, damages, or expenses (including those arising from negligence). I further agree to indemnify them against any third-party claims related to participation.

Medical Authorization
I authorize program staff to obtain emergency medical care for myself (or my child) as needed. I accept full financial responsibility for all related costs.

Media Release
I grant permission for the use of photos, video, or audio recordings of myself (or my child) for program purposes without compensation.

Binding Effect
This agreement is binding upon me, my heirs, and representatives, and is enforceable under Arizona law.

Acknowledgment & Signature
My signature below confirms that I have read, understood, and voluntarily accept the terms of this Waiver, Release, and Indemnification Agreement.
Electronic Signature Consent. By checking the box and signing my name below, I consent to the use of electronic signatures for this agreement. I understand my electronic signature is legally binding, just as if I had signed a paper copy.

I agree to the terms of this Waiver, Release, and Indemnification Agreement.
Date*

MonthDayYear
Date
Participants Name
Parent/Guardian Name (if minor)
Signature*

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Class / Payment Options:

Private Class (1)Classes are by appointment only. After completing your registration and payment, we will contact you to schedule your private session. You may choose a fully personalized 1-on-1 training, or a semi-private session where you can bring up to two friends or family members.

$100.00

Private Class Package (5)Classes are by appointment only. After completing your registration and payment, we will contact you to schedule your private session. You may choose a fully personalized 1-on-1 training, or a semi-private session where you can bring up to two friends or family members.

$450.00

Private Class Package (10 Classes)Classes are by appointment only. After completing your registration and payment, we will contact you to schedule your private session. You may choose a fully personalized 1-on-1 training, or a semi-private session where you can bring up to two friends or family members.

$900.00

Kids Member Group Classes (*Monthly Auto-Debit Membership) - K.E.E.P. ProgramJoin us every Tuesday and Thursday from 5:00PM-5:45PM at the Performing Arts Center, Sedona Charter School (excluding holidays). Classes are for members only and open to beginners through intermediate students and focus on building strength, flexibility, and self-defense skills in a fun, supportive environment. (*After your first payment, you will receive an Auto Debit Authorization Form link to complete, and memberships are billed on the 1st or 15th of each month. Monthly Membership pricing is based on auto-debit service. Non-Member Pricing is below. You may cancel your membership at any time with 30 days’ written notice.

$120.00

Adult Member Group Classes (*Monthly Auto-Debit Membership) - Movement ClassJoin us every Tuesday and Thursday from 5:45PM-6:30PM at the Performing Arts Center, Sedona Charter School (excluding holidays). Classes are for members only and open to beginners through intermediate students and focus on building strength, flexibility, and/or self-defense skills in a fun, supportive environment. (*After your first payment, you will be billed automatically each mont per the authorization terms above. Monthly Membership pricing is based on auto-debit service. Non-Member Pricing is below. You may cancel your membership at any time with 30 days’ written notice.

$120.00

Kids Group Classes Non-Member (Pay Per Month) - K.E.E.P. ProgramJoin us every Tuesday and Thursday from 5:00PM-5:45PM at the Performing Arts Center, Sedona Charter School (excluding holidays). Classes are open to beginners through intermediate students and focus on building strength, flexibility, and self-defense skills in a fun, supportive environment.

$160.00

Adult Group Classes Non-Member (Pay Per Month) - Movement ClassJoin us every Tuesday and Thursday from 5:45PM - 6:30pm at the Performing Arts Center, Sedona Charter School (excluding holidays). Classes are open to beginners through intermediate students and focus on building strength, flexibility, and self-defense skills in a fun, supportive environment.

$160.00

Adult Group Classes (Pay Per Day) - Movement ClassJoin us every Tuesday and Thursday from 5:45PM-6:30PM at the Performing Arts Center, Sedona Charter School (excluding holidays). Classes are designed for beginners to intermediate and focus on building strength, flexibility, and/or BJJ and self-defense skills in a fun and supportive environment.

$50.00

Kids Group Classes (Pay Per Day) - K.E.E.P. ProgramJoin us every Tuesday and Thursday from 5:00PM-5:45PM at the Performing Arts Center, Sedona Charter School (excluding holidays). Classes are designed for beginners to intermediate and focus on building strength, flexibility, and/or BJJ and self-defense skills in a fun and supportive environment.

$50.00

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Total

$0.00

Payment Methods

Debit or Credit Card

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K.E.E.P. / SedonaMoves Member Registration Form

Member Information

Emergency Contact Information

Waiver, Release of Liability & Indemnification Agreement

Class / Payment Options: