Ladies Self-Defense Seminar

Au Fitness & Martial Arts Academy

Ladies Self-Defense Seminar

Saturday, April 23, 2016

Richland Creek Community Church – Legacy Worship Center

Purpose: This Level 1 training is designed to teach basic self-defense techniques, elevate awareness and situational assessments and offer options for striking or fighting back. Code of Conduct: Respect, Integrity and Courtesy

REGISTRATION FORM:

(Students who participant must be signed-in by a parent/guardian and

identification is required Student ID/NC ID)

ALL REGISTRATION FORMS MUST BE SIGNED AND SUBMITTED BY APRIL 23

Drop off at Richland Creek Community Church

Attention: A.P. or Bridget Dinglasan/Self-Defense Seminar

Time: ☐ Women (18 yr. +) 9:00 am – 11:30 am

☐ Middle/High School 12:00 – 2:30 pm

☐ Early Registration (March 29-April 16) $40 | ☐ Late Registration (April 17-23) $50

Name: ______Age: ______

Address: ______

City: ______Zip: ______Phone #: ______

Emergency Contact: ______Cell #: ______

Email: ______

Dress Code: Appropriate sports wear – all students are expected to wear a dark shirt (short or long sleeve, no v-neck). Appropriate workout pants or capris (no tights!). Optional: Loose jeans and long sleeve shirt.

I understand that I will receive instruction in mixed martial arts (kenpo, judo, kickboxing and taekwondo) in accordance with the curriculum set forth by AU FITNESS & TRADITIONAL TAEKWONDO. This training will include controlled physical contact and self-defense instruction.

I attest that I am physically fit to participate in this form of instruction/activity and will notify the Instructor(s) and its designated Assistants of any physical condition that could affect my ability to participate in the course of instruction. I agree that Richland Creek Community Church, AU FITNESS & TRADITIONAL TAEKWONDO INSTRUCTORS and its representative/agents will not be held liable for any injuries or damages that may occur in the course of instruction and thereafter. I also give AUFTKD permission to publish video(s) and photos for advertisement and promotional purposes. I have read the information enclosed herein and understand my responsibilities as a participant.

______Date ______

Signature

Contact Information: | 919-649-5319