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Women’s Self-Defense Seminar – Participant Registration & Waiver
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1.
Full Name:
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2.
Date of Birth:
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3.
Phone Number:
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4.
Email Address:
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5.
Emergency Contact Name:
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6.
Emergency Contact Phone:
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7.
Do you have any medical conditions we should be aware of?
[Checkboxes]
No
Yes
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8.
If yes, please explain your medical conditions.
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9.
Do you have any injuries, mobility limitations, or physical restrictions?
[Checkboxes]
No
Yes
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10.
If yes, please explain your injuries or limitations.
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11.
Are you currently pregnant or recovering postpartum?
No
Yes
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12.
Do you have any conditions that may affect physical activity?
[Checkboxes]
No
Yes
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13.
If yes, please explain your conditions.
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14.
Have you participated in martial arts or self-defense training before?
No experience
Some experience
Intermediate/advanced
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15.
What is your main goal for attending?
[Checkboxes]
Confidence building
Basic self-defense skills
Fitness
Personal safety awareness
Other
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16.
If other, please specify your goal:
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17.
Participant Signature:
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18.
Date:
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19.
Parent/Guardian Signature (required for ages 10–17):
Please draw within the rectangle area below
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20.
Date:
Instructor Notes (Optional):
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21.
Attendance confirmed:
Yes
No
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22.
Payment received:
Cash
Card
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