Hidden Gem Self-Defense Seminar Registration

Hidden Gem Self-Defense Seminar Registration

Please fill out this form to attend the Self Defense Seminar on Sunday October 4th and/or Saturday November 21st from 10:30am - 12:00 pm! The seminar will be at Hidden Gem Martial Arts at 399 W Lincoln Hwy, Langhorne, PA 19047. Please contact Nikki Dunn at nadunn12@gmail.com or 570-762-6329 with any questions! The cost is $20 per participant for each seminar.
Name

First NameLast Name
Email
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Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Age
Which seminar(s) will you be attending?
Emergency Contact Name
Emergency Contact Phone Number
WAIVER

I, the undersigned, for myself, any heirs, executors and administrators thereof, recognizing there is a risk of injury, do hereby waive, release and forever discharge any and all rights and claims for damages which I may have or which may accrue against the seminar instructors, Hidden Gem Martial Arts, and other seminar participants for any and all injuries, losses, or damages, including, but not limited to personal injuries, property damage, or death, which may be sustained by me. I hereby state that I am physically fit to participate. I will obey all required rules and regulations and also assume full responsibility and liability for any of my actions during and in connection with this event. If I, or any of my guests, violate any event rules, I understand we will be ejected from the event, without a refund.
If you agree to the above waiver, please sign below.
Payment of $20 can be made in the following ways:
- Cash or check the day of the seminar
- Venmo: @Nicole-Dunn-74 by the day of the seminar
- Cash App: $NikkiDunn12 by the day of the seminar
If using a digital payment method, please write that it is for the self-defense seminar and the date you are attending (October 4th and/or November 21).

Thank you so much!
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