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I am a new student. |
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First Name |
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| Last
Name |
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| Any
other relatives taking this Leap with you? |
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| Phone
(Day) |
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| Phone
(Eve) |
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| Email |
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| Address |
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| City |
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State
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| Zip |
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Country
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| Age |
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| Profession |
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| Place
of Work |
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Emergency Contact |
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| Phone |
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Alternate
Phone
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| Relationship |
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Please
check which programs you are applying for:
(Please make sure both a program
and date are checked before submitting.) |
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* The fee for Leap of Faith is non-refundable and not
transferable to another person or date if you decide
not to take
the program after registering, or if you do not finish
the program. |
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Payment, Refund
and Cancellation Policy
Programs
must be paid in full in order for a space to
be held. The
Leap of Faith registration fee is non-refundable
and non-transferable. Cancellations must be made,
in writing, no later than two weeks prior to the program
start date. No refunds will be given after that time,
however, you may transfer your registration to another
participant up to the day of the seminar. Warrior
Spirit reserves the right to cancel seminars. In the
case of cancellation by Warrior Spirit, participants
will be contacted and transferred into another class.
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Health
Please
list and describe any physical conditions, injuries
or concerns that we should know about.
Are
you currently being treated by a mental health care
practitioner?
Yes
No
NOTE: If you are currently
under the care of, or have been treated by a mental
health practitioner within the last six months, we
highly recommend that you consult with them before
registering for this program.
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Teens
taking Leap of Faith...
If
you are applying to become a student for the Leap
of Faith, you must be 16 or older, and have a parent
or guardian take the class with you, or be a graduate
of this program. |
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Waiver
I
am aware that the nature of the Leap of Faith
consists of physical confrontations and challenges.
I voluntarily accept full responsibility for all risks
involved. I am also aware that the Leap of Faith
program contains simulated adult situations and language
with sexual content. I agree to release, hold harmless
and indemnify Warrior Spirit, and any of its employees,
staff members, volunteers, agents, contractors, subsidiaries,
officers or owners from all actions, claims or demands
for any loss, injury or damage which arises out of
my/my child's participation in, or travel to and from
Warrior Spirit or any Warrior Spirit activity, or
anywhere in the Warrior Spirit school/gym or on the
property where Warrior Spirit is located. This release
is also binding as to any other persons, including
all my family members, heirs, executors, and any other
minors which may accompany me. Warrior Spirit is a
non-profit organization.
I understand that Warrior Spirit records on audio
or video during sessions of the programs. I hereby
give permission for myself/my child to be audiotaped
and/or videotaped and/or photographed during any Warrior
Spirit class, workout or event. I also give permission
that such audio or videotape(s) and/or photograph(s)
may be used by Warrior Spirit for promotional, educational,
training or commercial purposes. Video tapes are not
released to anyone other than Warrior Spirit Directors.
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After
the "Submit" button is clicked, you will be
taken to a payment page.
Please note that you must pay online
in order for this registration form to be accepted. If you do not want to pay online (via Paypal)
please email
us for a registration form, and you can send it in with
a check or credit card number.
A space will NOT be held for you without payment in
full.
If you have any problems submitting this form, please call us at 425-818-4051. |
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