Women's Self Defense Course
Please submit one form per person. This is a 6 week course where participants are encouraged to complete every class. The instructor is Elliot Leung of CT Wing Tsun / Club Kung Fu.
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Age Range:
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18-29
30-39
40-49
50-59
60+
Under 18 (not eligible for this course)
Are you a member of the NIA?
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Yes
No, I will pay the $10 per class fee ($60 Total)
NICHOLS IMPROVEMENT ASSOCIATION, INC.SELF-DEFENSE CLASS ASSUMPTION OF RISK AND RELEASE OF LIABILITYIn consideration of my participation in the Nichols Improvement Association, Inc. ("NIA") Self-Defense Classes (the "Classes"), I knowingly and voluntarily accept sole and exclusive responsibility for, and assume the full risk associated with, any injuries, regardless of severity, that I may sustain and any damage to or loss of property that may occur as a result of my participation in the Classes. I understand that self-defense instruction involves physical activity, including but not limited to demonstrations, drills, partner exercises, and defensive techniques, all of which carry an inherent risk of injury despite reasonable precautions. I agree that, in the event I am injured, I will be responsible for my own transportation to and from any medical treatment facility. I hereby forever release, waive, and discharge Nichols Improvement Association, Inc., its officers, directors, instructors, volunteers, agents, and representatives from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or relating to any loss, damage, or injury that may be sustained by me or to any property belonging to me, whether caused by the negligence of the released parties or otherwise, while participating in the Classes, or while in, on, upon, or traveling to or from NIA property. I certify that I am physically able to participate in this Classes and understand that it is my responsibility to consult with my physician if I have any concerns regarding my ability to safely participate. I have carefully read this Assumption of Risk and Release of Liability and understand it fully. I acknowledge that this is a legally binding agreement that provides a comprehensive release of liability. I further understand that if any portion of this agreement is found to be unenforceable, the remaining provisions shall continue in full force and effect. Participant Code of Conduct I also willingly acknowledge and agree that: Any physical or verbal assault, harassment, intimidation, or threatening behavior directed toward an instructor, volunteer, staff member, participant, or spectator will result in immediate removal from the Classes and may result in suspension or permanent exclusion from future NIA programs, as determined by NIA. Obscene or abusive language, disruptive behavior, unsafe conduct, refusal to follow instructor directions, or any actions that compromise the safety of others are grounds for immediate removal from the Classes and may result in suspension from future NIA activities. If I am asked to leave the Classes due to my conduct, I agree to leave the instructional area and NIA property promptly. I understand that I remain responsible for my actions before, during, and after the Classes while on NIA property. By signing below, I acknowledge that I have read, understood, and voluntarily agree to the terms of this Assumption of Risk and Release of Liability.
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Submit
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