Illinois Fencers Club

Children’s Fencing Class Application Form

Please fill in all of the following information:

First Name: _______ Middle: _ Last: ______________

Date of Birth: __________________

Street Address: _________________________________________________________

City: ___________________________ State: _________ Zip: _________

Home Phone: (______) ______________Cell Phone: (_____)___________________

Parent / Guardian Work Phone: (______) ______________ x ______

E-Mail: ____________________

Name of Class: ______________________Start Date of Class: __________________

Class Registration Fees: Payment is expected at the first class. Checks should

be made payable to Illinois Fencers Club. Paid? Y/N

Emergency Contact & Phone No.: __________________________________________

PLEASE NOTE:

Illinois Fencers Club equipment (masks, jackets, foils, gloves, etc.) must remain at the club, so it is available for all to use. Return it to the cabinet after use – do not take it home or a fee may be imposed. Please treat the Club’s scoring equipment (reels, machines, etc.) carefully, because it is very expensive to replace.
Like any other sport, fencing has a few key safety rules that must be observed at all times. These include:

· Inspect equipment (mask, jacket, foil, etc.) for safety before use.

· No fencing, practicing, demonstrating, etc. with blades unless BOTH persons are wearing MASKS and

and other protective gear and you have the permission of the instructor.

· No fencing or practicing without a fencing jacket, pants, mask and a glove.

· Fence at a controlled pace, maintaining your balance at all times.

WAIVER OF LIABILITY

I understand that participation in any athletic sport, including fencing involves a possible risk of injury. I voluntarily recognize, accept and assume this risk, and I release the Illinois Fencers Club, its officers, instructors, members and agents, and the Mount Prospect Park District from any liability arising from any injury I, or my child may sustain.

Signature of Student:_______________________________________ Date: ___________________

Signature of Parent / Guardian: _______________________________ Date: ___________________

(If fencer is under the age of 18)

For your own safety, do you have any medical conditions in which the instructor should be made aware? Y/N

Please list any preexisting conditions: (asthma/ diabetes/ epilepsy/ hypertension, etc.)

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