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Freehold Fencing Academy

56 Thoreau Drive

Freehold NJ 07728

First Name --------------------------- Last Name--------------------------------D.O.B------------

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Please indicate any medical condition, which we should be aware of

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Method of Payment

Cash $ -------------------

Check $ ------------------- Made payable to Freehold Fencing Academy

$ 25 fee for returned checks

WAIVER OF LIABILITY_ I understand that participation in a sport carries a risk to me, or my child, of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept and assume this risk and release the Freehold Fencing Academy, LLC, their managers and coaching staff from any liability.

Signature of Fencer or Parent/ Guardian------------------Date -----------------

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