Clone of BUS SYSTEM YOUTH Registration Form

The Bancroft Urban Survival System ADULT REGISTRATION FORM
How did you hear about us?
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Athlete Information
Name

First NameLast Name
Date Of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Adult T-Shirt Size
Does the athlete have asthma, allergies, disabilities or any other medical conditions?
If yes, please describe.
Current Level of Experience.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact In Case Of Emergency
Name

First Name Last Name
Mobile Number

Area CodePhone Number
Name

First Name Last Name
Mobile Number

Area CodePhone Number
MEMBERSHIPS & PAYMENTS

My Products

Men's Monthly Combative Lessons$350.00

$350 for 1st month payment of combative lessons Monday-Thursday. Thereafter, payments are $250 per month. Includes 1 practice t-shirt with membership sign up.

Women's Monthly Combative Lessons $250.00

$250 for 1st month payment of combative lessons Sunday & Thursday. Thereafter, payments are $200 per month. Includes 1 practice t-shirt with membership sign up.

Private Monthly LessonsFree

Monthly private combative/self-defense lessons. The invoice will be emailed for payment.

Total $0.00

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

WAIVER ACKNOWLEDGEMENT
LIABILITY WAIVER & ASSUMPTION OF RISK AGREEMENT
The Bancroft Urban Survival System, LLC
Georgia

1. ACKNOWLEDGMENT OF RISK
I understand that participation in martial arts, self-defense training, executive protection training, fitness conditioning, sparring, drills, weapons training (training replicas only), and related activities involves inherent risks, including but not limited to:

Physical contact
Striking, grappling, joint locks
Falls or collisions
Muscle strains or sprains
Cuts, bruises, fractures
Serious bodily injury or death
I voluntarily choose to participate with full knowledge of these risks.

2. ASSUMPTION OF RISK
I knowingly and voluntarily assume all risks, known and unknown, associated with participation in activities conducted by:

The Bancroft Urban Survival System, LLC,
its owners, managers, instructors, employees, contractors, volunteers, and affiliates (collectively, “Released Parties”).

3. RELEASE OF LIABILITY (GEORGIA)
To the fullest extent permitted by Georgia law, I hereby release, waive, discharge, and covenant not to sue the Released Parties from any and all claims, demands, causes of action, damages, or liabilities arising out of or related to participation, including those resulting from ordinary negligence.

This release applies to:

Personal injury
Property damage
Emotional distress
Medical expenses
Any loss arising from participation

4. INDEMNIFICATION
I agree to indemnify and hold harmless the Released Parties from any claim brought by or on behalf of me or any third party arising from participation.

In the event of injury or medical emergency, I authorize The BUS System Academy staff to seek emergency medical treatment on my behalf.

I understand I am financially responsible for all medical costs.

5. SAFETY RULES COMPLIANCE
I agree to:

Follow all instructor directions
Use required protective equipment
Refrain from unsafe or reckless behavior
Immediately report injuries
Failure to comply may result in suspension or termination without refund.

6. NO GUARANTEE OF RESULTS
I understand that no specific training outcome, rank advancement, or physical result is guaranteed.

7. SEVERABILITY
If any portion of this Agreement is deemed unenforceable, the remaining provisions shall remain in full force and effect.

8. GOVERNING LAW & VENUE
This Agreement shall be governed by the laws of the State of Georgia, with venue exclusively in Georgia courts.

9. ACKNOWLEDGMENT & SIGNATURE
I HAVE READ THIS AGREEMENT IN FULL AND UNDERSTAND THAT I AM GIVING UP LEGAL RIGHTS BY SIGNING IT.
LIABILTIY WAIVER AND ASSUMPTION OF RISKS AGREEMENT Acknowledgement Initials
Media Waiver Acknowledgement

From time to time, The BUS System, LLC will post photographs of our athletes, coaches, and supporters online. I will let The BUS System know by email if I do not consent to my photos being shared.
Media Acknowledgement Initials
Medical Authorization

In the event of an injury or medical emergency, I allow The BUS System to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above.

I understand that all reasonable efforts will be made to contact the athlete’s emergency contact if an injury or medical emergency occurs.
Medical Acknowledgement Initials
By signing below, I comfirm that the information provided is accurate and I understand and agree to the terms of this registration.
Signature
Should be Empty:

The Bancroft Urban Survival System ADULT REGISTRATION FORM

MEMBERSHIPS & PAYMENTS

My Products

WAIVER ACKNOWLEDGEMENT