Figure 1 JUDO STANCE

2016-2017 SHORT COURSES

INTRO TO JUDO

Figure 1 JUDO STANCE

What: This program will be a self-defense program with instruction in the different defensive stances and techniques including learning how to fall and basic throws. Students should wear loose fitting clothing and tennis shoes.

Where: Knefely Gym on the campus of The Maryland School for the Blind, 3501 Taylor Avenue, Baltimore, Md. 21236.

When: Saturday, February 11, 2017 from 9AM – 3PM

Who: Middle and High School Students

Why: To have basic knowledge of defense if needed.

How: Contact Sara Borlie, at 410-4440-5000 ext. 1319 or for course information.

Cost: $10 per student (lunch provided)

Fax registration to: 410-319-5708

www.marylandschoolfortheblind.org

REGISTRATION - JUDO

PARTICIPANT INFORMATION:
Student: ______DOB: ______
Grade: ______School: ______
Parent(s): ______
Address:______City:______State:____ Zip:______
County: ______Vision Teacher: ______
Home Phone: ______Cell Phone: ______
Email: ______Siblings: ______

VISUAL INFORMATION (Students are required to bring portable low vision or Braille devices and canes):

Eye Condition:______

Level of Vision: ___ Totally Blind ___ Partially Sighted ___ Legally Blind ___ Wears Glasses

Field Loss: ___ Yes ___ No

Child uses the following for learning: ___ Regular Print ___ Large Print ____ Braille ___ Auditory Skills

Travel Skills: ___Independent ___Needs Supervision ___Uses Cane ___Prefers Sighted Guide

ADDITIONAL INFORMATION:

Other Disabilities: ______

Medications your child currently takes: ______

Allergies:

Medication (describe) ______

Food (describe) ______

Environmental (describe)______

RELEASE STATEMENTS:

Photo Release: Many pictures are taken during the programs of various activities. These pictures are sometimes used, along with press releases, to provide public relations information to television stations, newspapers and other publications. I grant permission for my family to be photographed for the above purposes.

___ Yes ___ No

Legal Guardian Signature:

______Date:______

Please fax or mail registration to:

The Maryland School for the Blind

Outreach Department

3501 Taylor Avenue

Baltimore, MD 21236

ATTN: Victoria Watt

Phone: 410-444-5000 ext. 1249 FAX: 410-319-5708

Email: