New Student Enrollment Form and Waiver Choose a Class *Sat 12pm (Children Age 5 - 7)Mon or Wed 4:30pm (Children 7 - 12)Intro. to Capoeira Youth & Adult (Mon. 6pm Thurs. 6:30pm))SelectHow did you hear about us?A friendGoogleFacebookRadioOtherFirst Name *Last Name *Age *Email Address *Phone Number *READ CAREFULLY WAIVER AND RELEASE OF LIABILITY * *I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify and it’s owners, agents, officers and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my participation in martial arts activities, I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers, volunteers I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE GRUPO AXE CAPOEIRA AND AFFILIATES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL or employees of Grupo Axè Capoeira and Affiliates . DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.Student Name / Name of Parent or Guardian, if student is a minor *DateStudent Applicant Signature / Signature of Parent or Guardian, if student is a minor *Date *In Case of Emergency Notify: *Send Message
