Emily Kwok World Champion Seminar REGISTRATION Form
When: Saturday & Sunday August 2-3, 2014
Where: (Fairfield Community Center) 61 Water Street, Fairfield ME 04937
Times: Kids 12 & under 11:00-12:00 both days! Adults 12:30-3:30 pm both days!
Cost: Kids $30 *Adults $65* Pre-Registration before July 15, 2014
Late Door Fee: Kids $55 and Adults $90
(Save money and Pre-Register)
Send fee & form to: Huard’s Martial Arts 234 Clinton Ave Winslow Me 04901 (# 207 649 8080)
Liability Release: I THE APPLICANT, RELEASE, WAIVE, AND DISCHARGE HUARD’S JUJITSU & KARATE INC. RANDY HUARD, MIKE HUARD, EMILY KWOK, STAFF,
FAIRFIELD COMMUNITY CENTER, AND ANYONE ELSE ASSOCIATED WITH THIS EVENT AND PRODUCTION FROM ANY AND ALL RIGHTS, CAUSES OF ACTIONS, AND CLAIMS I HAVE.
AS WELL AS DAMAGE I MAY SUFFER IN CONNECTION WITH MY APPLICATION, ENTRY AND PARTICIPATION IN THIS EMILY KWOK SEMINAR. There is always the chance I may suffer an
injury in this tough sport. I HEARBY ACKNOWLEDGE THAT I HAVE READ THE RULES FOR THIS EVENT AND I UNDERSTAND THEM. I UNDERSTAND IT IS MY RESPONSIBILITY TO OBTAIN
MEDICAL CLEARANCE FROM A QUALIFIED PHYSICIAN IN REGARDS TO PARTICIPATING IN THIS EVENT. I FURTHER UNDERSTAND THAT DUE TO THE RIGOROUS, STRENUOUS
NATURE OF THIS CLINIC, NO ONE CAN GUARANTEE I WILL NOT SUFFER AN INJURY, EVEN WITH PROPER SUPERVISION, AND MEDICAL SUPPORT. I ALSO GIVE PERMISSION FOR
THE USE OF MY PHOTOS, VIDEO FOOTAGE AND MY VOICE FOR ADVERTISEMENT OR SALES PURPOSES HEREIN.
Signature of participant or Guardian if under 18: ____________________________________________________________________________