White to Black Belt DVD Test Application
White to Black Belt DVD Test Application
First Name
Last Name
Parent's First Name (if applicable)
Phone Number
Cell Number
Date of Birth
Street
City
State
Zip Code
Email
Waiver
In consideration of your acceptance of my entry, I do hereby for myself, my heirs, executors, and administrators, waive, release and discharge against VILLARI SELF-DEFENSE CENTER and/or their departments, officers, agents, representatives, successors, and/or assigns, and against any participant for any and all damages which may be sustained by me in connection with my association with or entry in the above athletic event or events, or which may arise out of my traveling to, participating in, or returning from said event.
Accept Agreement