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Summer Registraton 2015

 

~~Waiver for non-karate participants


The Alaska Moving Arts Center is a nonprofit volunteer organization providing certain recreational and educational opportunities to the community. Each participant, individually or through his or her parent or guardian recognizes the possibility of injuries resulting from his or her participation in any of the activities or functions sponsored by the Alaska Moving Arts Center even though the activities and functions will be supervised and/or taught by adult volunteers or instructors. With that possibility in mind, it is the intent of the undersigned, by executing this document, to waive, release and hold harmless the Alaska Moving Arts Center, its officers, directors, staff, and volunteers from any and all liability for any injuries or damages sustained by the named participant, arising out of, in connection with, or resulting from participation in any activity or function sponsored by the Alaska Moving Arts Center.

Further, if the participant is a minor, the undersigned here by consents to emergency medical treatment, hospitalization or other medical treatment as needed for the welfare of the named participant by a physician, qualified nurse and or hospital in the event of injury or illness while participating in the event. In that regard, the undersigned, on behalf of himself or herself and the participant ,does hereby waive, release, and hold harmless the Alaska Moving Arts Center, its officers, directors, staff, and volunteers from any and all liability arising out of, in connection with, or resulting from such medical treatment.

Waiver for karate participants

Alaska Moving Arts center is a nonprofit volunteer organization providing certain recreational and educational opportunities to the community. The Eagle River Shotokan Karate Club is a club organized and operated by volunteers for the purpose of providing opportunities to train in traditional Shotokan Karate. A governmental agency or sports association certifies none of the volunteer instructors and none of the regular instructors receive compensation for their services.

Karate training can be a physically demanding activity, and like any other physical activity, can create cardiovascular risks as well as ricks of physical injury. Each participant, individually, or through his or her parent or guardian recognizes the possibility of injuries resulting from his or her participation even though the club employees generally accepted training techniques. With that possibility in mind, it is the intent of the undersigned, by executing this document, to waive, release and hold harmless the Alaska Moving Arts Center, its officers, directors, staff and volunteers from any and all liability for any injuries or damages sustained by the above-named participant, arising out of, in connection with, or resulting from training in karate.

Further, if the participant is a minor, the undersigned hereby consents to emergency medical treatment, hospitalization, or other medical treatment as needed for the welfare of the above-named participant by a physician, qualified nurse, and/or hospital in the event of injury or illness while participating in club functions. In that regard, the undersigned, on behalf of himself or herself and the participant, does hereby waive, release, and hold harmless the Alaska Moving Arts Center, its officers, directors, staff, and volunteers and members of the staff of the Eagle River Shotokan Karate Club from any and all liability arising out of, in connection with, or resulting from such medical treatment.

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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

How did you hear about the Alaska Moving Arts Program?
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

How did you hear about the Alaska Moving Arts Program?
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

How did you hear about the Alaska Moving Arts Program?
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

How did you hear about the Alaska Moving Arts Program?
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

How did you hear about the Alaska Moving Arts Program?
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

How did you hear about the Alaska Moving Arts Program?
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

How did you hear about the Alaska Moving Arts Program?
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

How did you hear about the Alaska Moving Arts Program?
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

How did you hear about the Alaska Moving Arts Program?
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

How did you hear about the Alaska Moving Arts Program?
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Summer camps
Summer classes
Pre-ballet classes ages 3-5
Pre-ballet I Tuesdays 9:30
Pre-ballet II Tuesdays 10:30
Ballet/Jazz Classes Ages 6 +
Ballet/Jazz I Thursdays 10:00
Ballet/Jazz II / III Thursdays 11:00
Performance Company
Performance Tuesdays 11:30
Tumbling ages 6-12
Interested in summer class
Social Dance
Tuesdays 7:00-8:30
Shotokan karate
Beginning Youth Mon/Wed 6:00-7:00 ages 6-12
Beginning Teen/Adult karate Mon/Wed 7:00-8:00
Inter / Adv youth Mon/Wed 6:00-7:00
Inter / Adv Teen/Adult M/W/F 7:00-8:00
Seibukan Jujutsu and Batto-Jujutsu
Teen / Adults Seibukan Tue / Thur 7:30-8:3
Batto-Jujutsu Thursdays 6:30-7:30
Tai Chi / Kung Fu
Tai Chi Saturdays 11:00-12:30
Synergy Martial Arts
Brazilian Jiu Jitsu/ Combat Submission Wrestling M/W 8:00-9:00 P.M. Sat 10:00-11:00
StX Kickboxing M/W 7:00-8:00 P.M Sat 9:00-10:00 a.m.
RAD Women's Self-Defense
RAD Basic Aug.13,14 and 15th
Interest List for Basic course
interest list for Advanced (Basic is pre-requisite)
Interest list for Key Chain Defense(Basic is a pre-requisite)
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

How did you hear about the Alaska Moving Arts Program?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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