Illinois Fencers Club

Adult/Teen 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:

1. 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.
2. 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 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 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.)

_________________________________________________________________________________________

How did you hear about this class? Circle: Park District Brochure/ Park District Web Site
IFC Web Site/ IFC Literature/ Other: _____________________