Note: If you were in our batizado 2010, please enter your e-mail address and we will retrieve your information. If you change your e-mail address please use your old e-mail address to retrieve your information and update your e-mail after that. Please review your information and update what it is necessary.
|
| |
| Contact Information |
e-Mail: |
|
| First Name: |
|
Last Name: |
|
Apelido (Nickname): |
|
Street Address: |
|
City: |
|
State: |
|
Zip Code: |
|
Country: |
|
Phone |
|
T-shirt Size |
|
| |
Emergency Contact Info |
|
Emergency Contact: |
|
Phone: |
|
Relationship |
|
Emergency Comments: |
|
|
|
Capoeira Information |
|
Group Name: |
|
Capoeira Teacher: |
|
Years Training
|
|
| Cordão: |
|
| |
| Housing (Please fill up if you need housing only) |
| Arriving Date: |
|
| Departure Date: |
|
| Special Accomodations: |
|
| |
|
| General Comments: |
|
|
Waiver |
I wish to participate in the 2011 UCA Encounter & Batizado promoted by the UCA (United Capoeira Association). I understand that instruction in martial arts and related activities such as CAPOEIRA involve strenuous exercise and personal body contact. As a condition to participate in this event, I assume the risk of all injury to myself; I agree to hold the school, its employees and agents harmless from any and all liability (including attorney's fees and costs) for all claims, action or damages due to injuries suffered by me or caused to someone else by me, arising out of capoeira and related activities, whether occurring at UCA or other facilities to be use. This Waiver and Assumption of Risk does not apply to claims, actions or damages caused by the gross negligence or intentional act or omission of the UCA. I agree to my image being captured, whether on film, video, or by photograph, during the course of the event. Further, I agree NOT to film or record any portion of the event without prior approval from the administration.
I have read the above release and agree enterely with its terms.
|
| |
|
If you have paid in the UCA office just press the register button. Remember to enter how much you pay in the general comments space.
|
|
|
|
| |
|
| For comments or questions please contact us at ucabatizado@capoeira.bz |
