West Country Swords

Fencer Name *

First

Last

Sex *

Age *

T-Shirt Size *

Water Bottle *

Payee Name *

First

Last

Email *

Contact Number *

Emergency Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Deposit paid by *

PayPal

Weapon *

Club *

Coach(s) *

Experience/Ranking *

Injuries *

If yes, please give details below: *

Medical Conditions: *

Current Medication: *

Permission for your child to attend the course and receive treatment (if required) by the School Staff, Sports Therapist and Coaches. *

No Yes

Permission to take photographs of your child for publicity purposes. *

No Yes

Permission to take photographs/videos of your child for coaching, analytical and feedback purposes. *

No Yes

Parent/ Gaurdian's Name *

First

Last

If the applicant is under 16 then the name of the person giving his/her permission must be stated in the box provided

ASSUMPTION OF RISKS: Fencing is a physical activity which, by its very nature, carries with it a certain inherent risk that cannot be eliminated regardless of the care taken to avoid injuries. Fencing classes include activities that involve strenuous exertions of strength using various muscle groups, quick movements involving speed and change of direction, and sustained physical activity which can place stress on the cardiovascular system.

The specific risks vary from one activity to another, but the risks range from minor injuries such as scratches, bruises, and sprains to major injuries such as eye injury, joint or back injuries, heart attacks and concussions.

WAIVER OF LIABILITY: In conclusion of my (my child’s) participation in the sponsored activities of the arranged by West Country Swords and its associates, I acknowledge, agree to and understand that: I am fully aware of and appreciate the risks, including the possible risk of serious injury associated with my (my child’s) participation. I further agree on behalf of myself, my heirs, and personal representatives, that Daniel Robinson, along with volunteers, agents, and lessee of the premises, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my (my child’s) participation in the sessions provided, or as a result of equipment that may have been provided to me for those activities.

DAMAGES & LOSS
Participants are respectfully advised that all personal property including sports equipment, clothing and money remains the sole responsibility of the participant. Daniel Robinson and its associates and will not be liable for any claim or expenses arising directly or indirectly as a result of loss, theft or damage to the personal belongings of any individual.

CONSENT FOR MEDICAL TREATMENT: This is to certify that I give my consent to West Country Swords & associates to obtain medical care from any licensed physician, hospital or clinic for the above named Participant for any injury or illness that may arise during activities associated with fencing classes or competitions.

You agree that we may publish your Personal Information as part of the results of the Event and may pass such information to any governing body or any affiliated organisation for the purpose of insurance, licences or for publishing results either for the event alone or combined with or compared to other events. Results may include (but not be limited to) name, any club/home country/regional/county affiliation, results, age category, penalties.

You also agree that in the event of a disciplinary or welfare incident that you are either involved in or witness, we may pass on your personal information to British Fencing or any other relevant Authorities for the purposes of supporting any investigatory activity into that incident.

Summer Camp ~ Day Rate Form

Athlete Information Form