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Freehold Fencing Academy 56 Thoreau Drive Freehold NJ 07728 First Name --------------------------- Last Name--------------------------------D.O.B------------ Address--------------------------------------------------------------------------------------------- City------------------------------ State---------------------Zip------------------------------------- Home Phone-------------------------------------Cell Phone---------------------------------------- E-Mail--------------------------------------------------------------------------------------------- Weapon(s) ------------------------------------ Fencing Experience--------------------------------- Parents/Guardian------------------------------------------------------------------------------------ Please indicate any medical condition, which we should be aware of-------------------------- ----------------------------------------------------------------------------------------------------- Method of Payment           Cash      $ ------------------- Check    $ -------------------        Made payable to Freehold Fencing Academy    $ 25 fee for returned checks     WAIVER OF LIABILITY_ I understand that participation in a sport carries a risk to me, or my child, of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept and assume this risk and release the   Freehold Fencing     Academy, LLC, their managers and coaching staff from any liability.           Signature of Fencer or Parent/ Guardian-------------------------------------Date-----------------