Hello Instructors, Parents & Students,
On Sunday May 7th, 2017 Master Nick Malefyt 7th Dan, and Guest Instructors Mr. George Boley Jr. 6th Dan, and Mr. Chris Leyesa 5th Dan will be conducting a Triple Impact Martial Arts training seminar OPEN to ALL styles of Martial Arts at the Legacy Life Center from 10:00am to 1:00pm. Please remember all applications need to be handed in to your instructor by this date.
All students, beginners, and walk ins are invited to attend and come train. If you have any questions, please contact your instructor.
See You There,
Christopher Leyesa 5th Dan
TRIPLE IMPACT SEMINAR APPLICATION
Last Name:______First Name: ______Address: ______
City:______State:______ZIP CODE:______
Age:______Sex:_____ Telephone:( )______E-mail:______
Date of Birth:______
In case of an emergency please contact:______Relation:______Telephone:( )______
Student Health Information:
Please provide any and all information to health and or pre-existing health conditions.
______
FEE INFORMATION
$40 pre-registered and $50 at the door
Make cash or checks
To: Legacy Life Center
Signature: ______Representative______
(If student is under the age of 18 years old a parent or guardian
must authorize application)
Legal Notes:
FOR SERVICE RECEIVED, and for other good and valuable consideration, the undersigned hereby agrees forever to indemnify and hold harmless Nick Malefyt, Chris Leyesa, George Boley, Jr. & Legacy Life Center from and against any and all claims, suits, damage or damages and/or loss or losses and/or action or actions of any kind as the result of and arising out of the transaction of this agreement. For participation requested, I do hereby, for my heirs, executors, and administrators, waive, release and forever discharge any and all rights and claims for damages which I may here after accrue to me against members of the seminar committee, Instructors, Schools Federations, and of their officers, agents, representatives, successors, and or assignees, competitions officials, and participants for any and all damages which may be sustained and suffered by me in connection with, association with, or entry in the seminar, or which may arise out of my traveling to, participate in or returning from said the event. My signature constitutes that I have read and fully understand all rules and regulations pertaining to my request for participation in this seminar event. Should I not abide by these terms, the seminar committee may cancel my right to participate in said events. NO REFUNDS.