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

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 ——-

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