Atlantic Training Center Registration Form

 
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New Member    Renewal Member  Male    Female
       
*  Last Name: *
Address:  City:
Postal Code:  D.O.B
Home Phone:  Work Phone:
Email: *    
* indicates a required field.
Registering Additional Family Members?
       
First Name:  D.O.B
First Name:  D.O.B
First Name:  D.O.B
First Name:  D.O.B
First Name:  D.O.B
       
Release of Liability, Waiver of Claims and Indemnity Agreement: In consideration of Atlantic Training Center accepting my application to participate in Judo activities, I agree:
 
1. To waive any and all claims that may I have in the future against Atlantic Training Center.
   
 
2. To release Atlantic Training Center from any and all liability for any personal injury, death, property damage, expense and related loss, including loss of income that I or my next of kin may suffer as a result of my participation in this activity, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory duty of care.
   
 
3. To hold harmless and indemnify Atlantic Training Center from any and all liability for any damage to property of, or personal injury to, any third party, resulting from my participation in this activity.
   
 
4. To allow the use of my name, photographic image, and relevant personal information for the promotion of judo in the media, judo related publications & websites, and for use by governing judo associations, when deemed appropriate by the Atlantic Training Center.
       
Funds to be submitted by cheque are to be made payable to Atlantic Training Center. No refund on cancelled registrations. NSF cheques will be assessed with all bank charges incurred by Atlantic Training Center.
 
Click here if you plan to pay by check, otherwise you will be forwarded to Paypal for payment options after clicking submit.