Welcome to the Kansas City Fencing Center!

Transcription

1 Welcome to the Kansas City Fencing Center! We re very excited that you have chosen to give fencing a try. In this bundle you will find both a Liability Release and a US Fencing Membership application. Please fill out both and bring them with you to class. The Release is a pretty standard document, but if you have any questions or concerns, please let me know. The Kansas City Fencing Center is a member club in the United States Fencing Association. As such, US Fencing supplies our liability insurance. A condition of our insurance is that every member of our programs must be a current member of US Fencing. Your class fees include a $5 non-competitive membership. We need you to fill out and sign the application, we will provide the payment information and process the forms. Here is a little information that may be helpful when filling out your form. Division is Kansas Division is based on Club Primary/Competition Club is Kansas City Fencing Center NCAA Affiliation is only for college fencers so you can leave it blank. If for some reason you need to change the class that you registered for you may do so by phone or , please do not fill out a second registration. When canceling or changing your registration, please let us know at least 48 hours in advance of the start of the class so that we can make that space available to someone on the waiting list. For those of you using a voucher of some kind (LivingSocial, AmazonLocal or Groupon), please note that your registration constitutes the activation of your voucher. If you register before the expiration date on your voucher you may choose any open class that fits your schedule, even if the start date of the class is after the expiration date on the voucher. If you have any questions or concerns, you may reach me at the phone# or below. Thank you for taking a few minutes to take care of these forms before coming in for your first class. We look forward to meeting you. Kelly J. Williams Executive Director / Head Coach Kansas City Fencing Center 913/ kcfc@kcfencing.org

2 Kansas City Fencing Center New Member Data Participant Last Name: First Name: Birth Date: / / Age: Address: Gender: Male Female Address: City: State: Zip: Phone: ( ) US Citizen? Yes No If no, Representing Country Parents Contact Information Father Last: First Phone( ) Mother Last: First Phone( ) Registration Information Start Date: Registered Through: KCFC check# Cash Blue Valley Recreation JoCo Parks & Recreation Olathe Recreation

3 (Family Name) Kansas City Fencing Center Family Release This document contains a release and waiver of your rights and the rights of those for whom you are responsible. Read it carefully before signing. If Fencer (as marked at the end of this Release) is under eighteen years of age, parent or guardian must also sign this Release. Fencer and parent or guardian (if applicable) acknowledges reading and understanding this ENTIRE Release. Fencer (and parent/guardian for his/herself and for Fencer) release and discharge the Kansas City Fencing Center, its officers, directors, its agents, servants, employees, and/or members, (collectively KCFC ) and affirmatively state, represent, promise, and agree: 1. The classes, training, tournaments and activities provided by KCFC (collectively Activities) are strenuous and may be physically harmful and/or emotionally stressful. 2. The Activities, including Fencing, are inherently dangerous and by participating Fencer risks serious injury. 3. If Fencer has a disability or illness, or is being treated by a health care provider, Fencer s health care provider should be consulted before and/or during participation in the Activities. 4. Fencer understands and agrees that KCFC has the right to terminate Fencer s participation in the Activities if, in its sole discretion, Fencer is, or puts others, at risk of physical or emotional harm by participating in the Activities. 5. KCFC reserves the right to decline membership to and/or expel Fencer for any reason. 6. Fencer (and parent/guardian) agrees that Fencer and Fencer s heirs, legal representatives, and assigns: Will not make a claim against KCFC for any injury, or damage, of any kind, resulting from, or in any way related to, the Activities. Release and discharge KCFC from all claims or demands arising from injury or damage caused by, or in any other way related to, my participation in the Activities. Fencer travels to and from KCFC at his/her own risk. KCFC is NOT RESPONSIBLE for Fencer leaving KCFC s premises (including, but not limited to any building it owns or leases, or its parking lot) with or without the permission of KCFC or Fencer s parent or guardian. Fencer waives any claims against KCFC, for injury suffered while traveling to or from KCFC and to or from tournaments by public, private or any other means of conveyance. 7. I have carefully read and fully understand this document and its contents. By signing this release, I state Fencer is in good physical condition and is not aware of any disease or injury that may result in being injured while participating in any KCFC program. I the undersigned, as a Fencer, parent or guardian certify and consent to participation in the Activities and tournaments at KCFC and further agree to abide by its provisions for myself, and any named minor.

4 INSTRUCTIONS: Please date, print your name and sign for all Fencers and Parent/Guardians. Mark Fencer (x) if signer is a fencer by participating in the Activities; mark Parent/Guardian (x) if signer is the parent or guardian of a Fencer; Mark both Fencer and Parent/Guardian, if applicable. Date

5 RELEASE AND WAIVER OF LIABILITY -- READ BEFORE SIGNING In consideration of being allowed to participate in any way in the USA Fencing Association and its related events and activities, I, [print name], the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in the sport of fencing and related activities is significant, including the potential for serious injury or death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. If, however, I observe any unusual significant hazard during my presence or participation in any such activity, I will bring such hazard immediately to the attention of an official, organizer or other person with responsibility for such activity; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I agree to comply with the stated and customary terms and conditions for participation, including but not limited to those set forth in USA Fencing s Fencing Rules, Athlete Handbook and Safe Sport Policy, as amended from time to time; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS USA FENCING, and any affiliated section, division, club, host organization, officer, director, referee, coach, volunteer, official, agent and/or employee, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY. x Age: PARTICIPANT'S SIGNATURE Date Signed: FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. x PARENT/GUARDIAN S SIGNATURE Date Signed Membership Type Requirements and Benefits Competitive: Any fencer who wishes to compete at a local, regional, or national level. Benefits include: Right to compete: Recognition as a member of USA Fencing, online membership profile/card and passport to worldwide fencing Subscription to American Fencing Magazine USA Fencing Quarterly Publication Voting Privileges: Members 18 and over, as of February 1st of the membership year, have the right to vote in USA Fencing elections Secondary Medical/Accident Insurance: Covers USA Fencing sanctioned activities (contact USA Fencing National Office for policy specifics.) Discounts on Travel and Fencing Equipment available on the USA Fencing website Your dues support the sport at all levels from grassroots to the Olympic and Paralympic Games Collegiate Competitive: Benefits same as Competitive members with the following requirements: Individual must be listed as a member on an approved roster submitted by a College/University fencing club with a current USFA Affiliate or Club membership OR Individual must be a member of an NCAA fencing program. Professional: Member will be required to successfully complete a background screening. If background check is not successfully completed within 30 days after receipt of application, membership will revert to Competitive level. Benefits same as Competitive with the following additions: Certificate of recognition Coach Credential (membership card) General Liability Insurance Coverage through the USA Fencing Policy (contact the National Office for policy specifics) Life Installment: (Formerly known as Supporting Life) Benefits same as Competitive- Payment of 1/10 of life dues for 10 consecutive years, after which membership converts to Life Membership. Life: Same as Competitive, valid until death. Life Benefactor Membership: Life members may show their continuing support of USA Fencing by upgrading to Benefactor status. Benefactor memberships are grouped in four levels (Endowment/Patron/Benefactor/Philanthropist), with the dues determined by the Board of Directors. Contact the National Office for more information. Supporting (non-competitive): Benefits same as Competitive with exception of Right to compete. Non-Competitive: Membership include secondary medical/accident coverage during USA Fencing sanctioned activities, but does not include right to compete or vote. Membership is upgradeable to competitive membership upon payment of dues equivalent. How to Contact USA Fencing 4065 Sinton Road, Suite 140, Colorado Springs, CO TEL: (719) FAX: (719) information@usfencing.org