Feel Safe! Be Safe! - Academy of Traditional Karate

Life Defense Seminar:
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!
!
BRING A GUEST!
No prior Martial
Arts experience
required!
Feel Safe! Be Safe!
This Seminar is for men and women.
We will teach basic self defense
techniques as well as scenario based
training. There will also be a cardio
and practical bag hitting section so
you’ll get a great workout too!
!
Date: Saturday, March 8!
Time: 12:00 pm- 1:30 pm!
Cost: $10
!
Registration Deadline: 3/3/14!
*Note: Students should wear an
Academy T-shirt and bring sneakers.
Non-members should wear
comfortable clothing and sneakers.!
Note: 12 person minimum to run event
Registration form on Reverse Side
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Disclaimer of Liability
The undersigned parent/guardian and student ______________________ hereby releases, waives, and agrees to
indemnify and hold harmless The Academy of Traditional Karate, Inc., Todd J. & Kristen A. Keane, their authorized
agents and representatives, and Howland Development from any and all liability arising from or in relation to or on the
premises designated for the practice of karate in sanctioned classes and events of all descriptions, namely life defense
Seminar, including personal injuries sustained in the customary course of practice.. In addition, if I or my child has any
known medical conditions, I will consult a physician, and I will supply a physician’s note.
!Parent or Guardian _____________________________________________
!
Date _______________
Signature of Student: ________________________________!
Date: ___________
Student ______________________________________________________
Date________________
!
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!
Non-Member Registration Form
Name ____________________________
Email ____________________________
Tel. # ____________________________
Address __________________________
City ___________________ State ______ Zip ________
Allergies/Medical Conditions___________________________________
Disclaimer of Liability
The undersigned parent/guardian and student ______________________ hereby releases, waives, and agrees to
indemnify and hold harmless The Academy of Traditional Karate, Inc., Todd J. & Kristen A. Keane, their authorized
agents and representatives, and Howland Development from any and all liability arising from or in relation to or on the
premises designated for the practice of karate in sanctioned classes and events of all descriptions, namely life defense
Seminar, including personal injuries sustained in the customary course of practice.. In addition, if I or my child has any
known medical conditions, I will consult a physician, and I will supply a physician’s note.
!Parent or Guardian _____________________________________________
!
Date _______________
Signature
of Participant: ________________________________! Date: ___________
Student ______________________________________________________
Date________________
!
!
!"#$%&'()*+,*(-&*./(
"##$!%!&'(%)*+,!!-.#/0!.#1#!23!4*'1!+##$!)*!*1$#1!*+#5!!!
67#%3#!%))%/.!%!/.#/0!*8!9:!;%4%(7#!)*<!=/%$#>4!*8!?1%$2)2*+%7!&%1%)#!
@*1!).#!;'1/.%3#!*8!%!0'(%)*+!