Great Lakes Global Taekwon-Do 5429 Schultz Drive, Sylvania, OH 43560  419.882. 9934 email:Carol@greatlakestaekwon-do.com

Master Wheatley's Seminar

February 13, 2010

 

 

Name _____________________________________Sex_____ Age _____ Rank ______

Address: _______________________________________________Phone: ______________

City: ______________________________ State: _______________ Zip: ________________

School :___________________________________Instructor: _________________________

Emergency Contact: ________________________________Phone: ____________________

ITF/USITF: Yes ___  No ____  Total Amount Enclosed $_______________________

Cost $50.00 per person preregistration   After February 7, cost $60.00

Hold Harmless Agreement

For participation requested I the undersigned have been informed and understand that Taekwon-do can cause injuries both minor and severe.  I acknowledge that I am voluntarily participating in this seminar and I assume full responsibility for all of my actions in connection with said seminar.  I do hereby, agree to completely release and discharge members of the seminar committee, Great Lakes Global Taekwon-do, and its employees, agents, and volunteers (collectively, the "agents"), Olivet Lutheran Church and its agents, the United States International Taekwon-do Federation, and all of their officers agents, representatives, successors, from any and all claims, demands, damages, and causes of actions that I currently have or may acquire in the future.  I assume full responsibility for all personal injuries or damages that 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 or returning from said event.  I agree that the above organizations and their agents shall not be liable for any such injuries or damages, claimed by myself members of my family and/or my estate, against any person or organization connected with the Great Lakes Global Taekwon-do, Olivet Lutheran Church, and United States International Taekwon-do Federation.  In addition, the school and its agents will not be liable for the loss or theft of any personal property.

Signature: ______________________________________________Date: _______________

Guardian Signature (under 18) _____________________________ Date: ______________

Please check the box below if you would like to join us for dinner after the seminar.  Please place the number of people attending if more than 1.