South Denver Fencing Academy, LLC Registration Form

Last Name: ____________________ First Name: ___________________ MI: ______

Street Address: ___________________________________________ Apt # ____________

City: ________________________ State: ________ Zip Code: __________-_______

Phone #’s Home: ________________________ Work: _________________________M, D or Self

     Cell: _________________________  M, D or Self    Cell: _________________________  M or D

Email Address: ____________________@___________

Your email address will only be used by South Denver Fencing Academy, LLC for the purposes of contacting members regarding this organization’s business and announcements. It will not be sold or distributed for any other purpose.

Date of Birth _____/_____/________

Do you have any allergies/medical conditions that SDFA should be aware of? If so, please give details: ________________________________________________________________________

How did you find out about South Denver Fencing Academy? (Check all that apply)

USFA website_____ Online search_____ Yellow Pages______

Friend____ If so, friend’s name__________________________ Other: _______________________

^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^

If fencer is under the age of 18, please fill in below:

___Parent’s name: ___________________________ Address: ____________________________

                        City: ________________________ State: _______ Zip Code: ______________

___Parent’s name: ___________________________ Address: ____________________________

                        City: ________________________ State: _______ Zip Code: ______________

*Please check to which parent we should send all invoices.

Current school: _________________________________________ Grade: _____

^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^

Please bill my credit card each month:   

Name as it appears on card: ___________________________________________

#_______-_______-_______-_______ Exp._____/_____ 3 digit # from back of card ________

Signature of Fencer: __________________________________ Date: _____/_____/________

Parent/Legal Guardian: _______________________________ Date: _____/_____/________

If the fencer is under the age of 18, the Parent/Legal Guardian must also sign registration form.

 

 

 

 

 

SOUTH DENVER FENCING ACADEMY, LLC

WAIVER OF LIABILITY

I understand and appreciate that the participation in fencing as a sport carries a risk to me of serious

injury, including permanent paralysis or death. I agree to abide by the rules of South Denver Fencing

Academy, LLC and the United States Fencing Association. I enter the classes and events sponsored by

South Denver Fencing Academy, LLC voluntarily and at my own risk, and knowingly recognize,

accept, and assume this risk and release South Denver Fencing Academy, LLC, the United States

Fencing Association, and their sponsors, employees, agents, contractors, volunteers, event organizers,

and officials from any and all liability.

 

_____________________________________ X____________________________________

Fencer’s Printed Name                                                                     Fencer’s Signature                                                        Date

 

_________________________________________________________________________________

Signature of Parent or Guardian for Minor                                                               Date

 

CONSENT FOR MEDICAL TREATMENT

This is to certify that on this date, I, ________________________________, give my consent to South

Denver Fencing Academy, LLC and its representatives to obtain medical care from any licensed

physician, hospital or clinic for the fencer/s named below for any injury or illness that may arise during

activities associated with classes and events sponsored by South Denver Fencing Academy, LLC.

_________________________________ x______________________________________

Fencer’s Printed Name                                                        Fencer’s Signature                                             Date

 

______________________________________________________________________________________

Signature of Parent or Guardian for Minor                                                       Date

Address: ___________________________City: _________________Zip Code: _____________

 

Phone #: Home __________________ Work ___________________ Cell ____________________

 

Birth date if fencer is under the age of 18: ______/______/__________

If said fencer/s has medical insurance, please provide the carrier information:

 

__________________________________     __________________________________

Name of Carrier                                                                           Name of Policyholder

 

_________________________________________      _________________________________________

Address of Carrier                                                             Policy Number

 

Emergency contacts:

 

Name: _____________________________ Phone #: ________________________

 

Name: _____________________________ Phone #: ________________________

 

 

PHOTOGRAPHY WAIVER

Any photographs taken during classes, lessons, camps or special events are the property of South Denver Fencing Academy, LLC and may be used at their discretion.

 

X________________________________________  X________________________________________

   Fencer’s Signature                                                               Date                 Signature of Parent or Guardian for Minor                      Date

 

SDFA Code of Conduct  

In order to ensure a safe, productive and sportsmanlike atmosphere for all our members, everyone who uses our facility must adhere to our code of conduct, and is expected to hold one another to these standards.  By using our facilities, you agree to abide by this code and be subject to its disciplinary provisions.  We expect you to show respect for our fencers, coaches, visitors, staff, facility and the rules of the game.  We expect you to be of good will with one another when differences arise and be generous and flexible as we strive to meet the needs of all of our fencers.  Use of tobacco products and alcohol are prohibited on the premises.  

Yellow Cards  

Fencer must behave in a sportsmanlike manner at all times.  Behavior that would get you a warning or yellow card at a competition will get you a warning or yellow card at the club.  This includes, but is not limited to the following specific prohibitions:

  

Fencers who continue to violate these guidelines after being told to stop will be required to stop fencing for the remainder of the class.  Parents/Guardians will be notified for fencers under age 18.  

Black Cards  

If your behavior would get you a black card at a competition, it will get you a black card at the club.  SUCH BEHAVIOR WILL RESULT IN YOUR BEING REQUIRED TO LEAVE THE FACILITY IMMEDIATELY AND INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING SPECIFIC PROHIBITIONS:  

Fencers who are black-carded are subject to suspension from the club and will be prohibited from the use of the facilities.  The owners/managers of SDFA will review all black cards to determine the length of suspension.  Fencers may appeal suspensions to the owners/managers, but the decision of the owners/managers will be final.  Refunds will not be issued for unused dues and fees.  

I agree to abide by the South Denver Fencing Academy’s Code of Conduct, and be subject to the Code’s disciplinary provisions.  

__________________________________________________                   ________________

Signature of Fencer (all fencers must sign)                                                 Date

 

 

__________________________________________________                   _________________

Signature of Parent/Guardian (for fencers under age 18)                                Date