Registration Form

2010 Summer Camps

Alliance Fencing Academy, Houston

Youth 7-14

___ June 1-5, ___ June 7-11, ___ June 14-18, ___June 28-July 2,

___ July 19-23, ___ July 26-30,

___ August 2-6, ___ August 9-13

Student name: ____________________________________________

Age: _____ Gender: M , F Fencing experience: _____________

Address: _________________________________________________

_________________________________________________

Home phone: ___________________ Cell: ______________________

E-mail: ___________________________________________________

Parent name: ______________________________________________

In case of emergency please call: __________________________ , ___________________________

(Name) (Phone)

Alliance Fencing Academy, LLC is a member of the United States Fencing Association (USFA) with

its certified insurance.

_____ (Initial) WAIVER OF LIABILLITY

Upon entering events sponsored by the USFA and/or its member Alliance Fencing Academy, I agree

to abide by the rules of the USFA, as currently published (www.usfencing.org). I understand and appreciate that participation in a sport carries a risk to me of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept and assume this risk and release the USFA, their sponsors, event organizers and officials from any liability.

Parent signature _________________________ Date: ___/___/___

(Required for fencers under 18)

Amount Enclosed: $ ________