Please print the correct form below, fill it out and return to:
BKFTC
Attn: Joshua Grant
883 Boylston Street,
Boston, MA 02116
Summer 2019
Form: Summer, July 11-14, 2019
BOSTON KUNG FU TAI CHI INSTITUTE
Summer 2019
WATERVILLE VALLEY, N.H.
July 11-14 $425
NAME __________________________________________________________________________DATE OF BIRTH __________/__________/__________
HM PHONE ___________________________ WK PHONE__________________________________________CELL PHONE______________________
ADDRESS________________________________________________________ CITY, STATE, ZIP_____________________________________________
PLEASE RESERVE EARLY IN ORDER TO MAKE PROPER ARRANGEMENTS
PLEASE MAKE CHECK PAYABLE TO:
BOSTON KUNG FU TAI CHI INSTITUTE
FOR FURTHER INFORMATION PLEASE CALL (617) 262-0600
RELEASE OF LIABILITY IN CASE OF INJURY
In consideration of the risk of injury while participating in this summer camp (the “Activity”) and as consideration for the right to participate in the activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity and do hereby release and forever discharge Li Grant, Inc. DBA BKFTC, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns for any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to the Activity.
I am voluntarily participating in the aforementioned activity and am participating in the activity entirely at my own risk. I assume all related risks, both known or unknown to me, of my participation in this activity including travel to, from and during this activity.
I agree to allow any photos or video taken of me to be used for advertising on behalf of BKFTC and their affiliates.
Signature: ______________________________________________________________________________________ Date _______/_______/__________
Parent/Guardian if under 18 ________________________________________________________________
Summer 2019
WATERVILLE VALLEY, N.H.
July 11-14 $425
NAME __________________________________________________________________________DATE OF BIRTH __________/__________/__________
HM PHONE ___________________________ WK PHONE__________________________________________CELL PHONE______________________
ADDRESS________________________________________________________ CITY, STATE, ZIP_____________________________________________
PLEASE RESERVE EARLY IN ORDER TO MAKE PROPER ARRANGEMENTS
PLEASE MAKE CHECK PAYABLE TO:
BOSTON KUNG FU TAI CHI INSTITUTE
FOR FURTHER INFORMATION PLEASE CALL (617) 262-0600
RELEASE OF LIABILITY IN CASE OF INJURY
In consideration of the risk of injury while participating in this summer camp (the “Activity”) and as consideration for the right to participate in the activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity and do hereby release and forever discharge Li Grant, Inc. DBA BKFTC, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns for any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to the Activity.
I am voluntarily participating in the aforementioned activity and am participating in the activity entirely at my own risk. I assume all related risks, both known or unknown to me, of my participation in this activity including travel to, from and during this activity.
I agree to allow any photos or video taken of me to be used for advertising on behalf of BKFTC and their affiliates.
Signature: ______________________________________________________________________________________ Date _______/_______/__________
Parent/Guardian if under 18 ________________________________________________________________
