STUDENT ENROLLMENT FORM
CONDITIONS FOR ENROLLMENT AND PARTICIPATION
Due to the physical nature of the courses taught, you are hereby advised of the following: If you are pregnant; suffer from a chronic/acute problem of the neck, back, wrist, knee, heart, or muscular system; or other medical conditions such as a stress disorder, hypertension, hip bursitis and so forth, YOU SHOULD NOT PLAN TO PARTICIPATE IN THE PROGRAM WITHOUT FIRST CONSULTING WITH YOUR PHYSICIAN.
INSTRUCTION DOES INVOLVE PERIODS OF PHYSICAL ACTIVITY AND SOME RISK OF INJURY DOES EXIST.
Although the instructor(s) will attempt at all times to maintain a high degree of care for the safety of all persons attending the course, it must be understood that neither the instructor, the organization sponsoring this instruction or the Bushwhacker Training Academy will assume financial or other responsibility for injuries or illnesses suffered from, or relating to, any training received, nor can it be responsible for any loss to attendees as a result of damage of their property through fire, theft, or other causes. You, the attendee, must understand that you are participating in this training at your own risk. Therefore, prior to permission being granted for your attendance, you must agree, by signature, to the condition set forth below.
I, the undersigned, accept all risk that may be associated with this training and having read and understood the above statements. I agree to indemnify and hold harmless the instructor(s) where are Jens D. Barclay and the Bushwhacker Training Academy.
I acknowledge that the training involves a degree of physical exercise and therefore does involve a risk of injury to me. I also acknowledge that I do not have any of the above described or other injuries, illnesses, disabilities, or conditions which could be made worse by my participation or otherwise cause me harm during this training. I am in good physical and mental health. I agree to abide by the course safety rules and instruction given by the instructor(s). I have read and fully understand the terms and conditions of this agreement.
Signature_________________________________ Date:________________
____________________________________________________________________________________________
Please Print:
Last Name____________________________________ First name________________________ MI___________
Home Address_________________________________ City___________________________ ZIP_____________
Home Phone Number___________________________ Work Number____________________________________
Email_______________________________________
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY______________________________________________
Phone number__________________________________________
CONDITIONS FOR ENROLLMENT AND PARTICIPATION
Due to the physical nature of the courses taught, you are hereby advised of the following: If you are pregnant; suffer from a chronic/acute problem of the neck, back, wrist, knee, heart, or muscular system; or other medical conditions such as a stress disorder, hypertension, hip bursitis and so forth, YOU SHOULD NOT PLAN TO PARTICIPATE IN THE PROGRAM WITHOUT FIRST CONSULTING WITH YOUR PHYSICIAN.
INSTRUCTION DOES INVOLVE PERIODS OF PHYSICAL ACTIVITY AND SOME RISK OF INJURY DOES EXIST.
Although the instructor(s) will attempt at all times to maintain a high degree of care for the safety of all persons attending the course, it must be understood that neither the instructor, the organization sponsoring this instruction or the Bushwhacker Training Academy will assume financial or other responsibility for injuries or illnesses suffered from, or relating to, any training received, nor can it be responsible for any loss to attendees as a result of damage of their property through fire, theft, or other causes. You, the attendee, must understand that you are participating in this training at your own risk. Therefore, prior to permission being granted for your attendance, you must agree, by signature, to the condition set forth below.
I, the undersigned, accept all risk that may be associated with this training and having read and understood the above statements. I agree to indemnify and hold harmless the instructor(s) where are Jens D. Barclay and the Bushwhacker Training Academy.
I acknowledge that the training involves a degree of physical exercise and therefore does involve a risk of injury to me. I also acknowledge that I do not have any of the above described or other injuries, illnesses, disabilities, or conditions which could be made worse by my participation or otherwise cause me harm during this training. I am in good physical and mental health. I agree to abide by the course safety rules and instruction given by the instructor(s). I have read and fully understand the terms and conditions of this agreement.
Signature_________________________________ Date:________________
____________________________________________________________________________________________
Please Print:
Last Name____________________________________ First name________________________ MI___________
Home Address_________________________________ City___________________________ ZIP_____________
Home Phone Number___________________________ Work Number____________________________________
Email_______________________________________
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY______________________________________________
Phone number__________________________________________