Herefordshire Fencing Club

Member Contact Info

* Indicates required field

Fencers Name

Name *

First

Last

Gender *

Telephone *

D.O.B *

Mobile *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

School *

Weapon *

Foil Epee

Other Clubs *

Permission to take photographs/ videos of you (your child) for publicity/ training purposes during our sessions or at competitions. *

Yes No

Medical Information *

Emergency Contact

Name *

First

Last

Mobile *

Relationship *

Name *

First

Last

Mobile *

Relationship *

Waiver & Liability

ASSUMPTION OF RISKS: Fencing is a physical activity which, by its very nature, carries with it a certain inherent risk that cannot be eliminated regardless of the care taken to avoid injuries. Fencing classes include activities that involve strenuous exertions of strength using various muscle groups, quick movements involving speed and change of direction, and sustained physical activity which can place stress on the cardiovascular system.

The specific risks vary from one activity to another, but the risks range from minor injuries such as scratches, bruises, and sprains to major injuries such as eye injury, joint or back injuries, heart attacks and concussions.

WAIVER OF LIABILITY: In conclusion of my (child’s) participation in the sponsored activities arranged by Draig Wern Fencing Club, I acknowledge, agree to and understand that: I am fully aware of and appreciate the risks, including the possible risk of serious injury associated with my (child’s) participation. I further agree on behalf of myself, my heirs, and personal representatives, that coaches along with volunteers, agents, and lessee of the premises, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my and my child’s participation in the club’s events, or as a result of equipment that may have been provided to me (my child) for those activities.

CONSENT FOR MEDICAL TREATMENT: This is to certify that I give my consent to Draig Wern Fencing Club to obtain medical care from any licensed physician, hospital or clinic for the above named Participant for any injury or illness that may arise during activities associated with fencing classes or competitions.

This is the data that is held by Draig Wern Fencing Club. The address data is used to maintain contact with you. The medical data is required so that the coaches are aware of any issues you/ your child have. *

I accept that Draig Wern Fencing Club can hold this data.

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By ticking the box you agree to the terms stated in the Waiver above.

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