REGISTER - STEP ONE

Household Details

Household Size:

Do parents or student have outstanding obligations to any previous club, or any outstanding fees, dismissals or suspensions?
If Yes, please provide details:

Registration fee includes membership in the United States Fencing Association*, the national governing body for the sport of fencing in the United States.


DECLARATION: Students and parents/guardian agree that if student does not comply with the Academy's Code of Conduct, the student may be sent home at the discretion of the teacher/coach/sponsor/chaperone, at student’s expense, and the student’s family will be responsible for all financial and other consequences of the student’s behaviour. Any student whose behaviour warrants the potential for being sent home will be addressed as the teacher/coach/sponsor/chaperone deems appropriate after a conversation involving the teacher/coach/sponsor/chaperone, the student, and a parent or guardian.

Student recognizes that the teachers/coaches/sponsors/chaperones are responsible for my welfare and for the welfare of everyone participating in the program. I will, therefore, cooperate with them by listening to and following their instructions.

Student agrees to abide by the rules of the Academy and acknowledge the need to comply with the Academy’s Code of Conduct. I understand and accept that should I transgress from the codes and standards of the Academy, I will be subject to the Academy’s disciplinary procedures, up to and including dismissal from the program.

Waiver, Release of Liability and Hold Harmless

I am the parent or legal guardian of (“Minor”) who has enrolled in a Bronzeville Fencing Academy (“Academy”) program. In return for the Minor being accepted into a program being offered by the Academy (the “Program”), I acknowledge that I understand the nature of the Program, and believe that Minor is qualified and in proper physical condition to participate in the Program. I further agree that if at any time, I or Minor believes conditions to be unsafe with respect to Minor’s physical condition, the equipment, or facilities, it shall be I and/or Minor’s responsibility to, and I and/or Minor will, immediately discontinue participation in the Program.

I further acknowledge that the Program may involve the risk of bodily injury (including the possibility of permanent disability, paralysis, or death), which may be caused by (a) Minor’s own actions or inactions, (b) the actions or inactions of others participating in the Program, or (c) the condition of the equipment and/or facilities at which the Program is located and I fully accept and assume all such risk and all responsibility for losses, costs, and damages Minor may incur as a result of Minor’s participation in the Program.

In addition, the undersigned acknowledges that novel Coronavirus (''COVID-19") infections have been confirmed throughout the United States, including cases in ILLINOIS and the CITY OF CHICAGO. In accordance with the most recent guidance and protocols issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the Illinois Department of Health (IDPH), and the Chicago Department of Public Health (CDPH), for slowing the transmission of COVID-19, the undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of the ACADEMY (other than any exclusively online services and programs) within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice and Chicago Department of Public Health Emergency Travel Order, (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice and Chicago Department of Public Health, Emergency Travel Order, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The CDC Travel Health Network and Chicago Department of Public Health is continuously updating this list and the undersigned agrees that they are aware of this list and the countries and states listed.

The undersigned agrees to check the CDC Travel Health Notices list (https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html) and Chicago Department of Public Health Emergency Travel Order (https://www.chicago.gov/city/en/sites/covid-19/home/emergency-travel-order.html) prior to utilizing the facilities, services, and programs of the ACADEMY, on a daily basis if necessary. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of the ACADEMY if he or she (i) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) has a suspected or diagnosed/confirned case of COVID-19. The undersigned agrees to notify the ACADEMY immediately if he or she believes that any of the foregoing access/use restrictions may apply.

The ACADEMY has taken certain steps to implement recommended guidance and protocols issued by the Public Health Agencies for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that the ACADEMY may revise its procedures at any time based on updated recommended guidance and protocols issued by the Public Health Agencies and further agrees to comply with the ACADEMY's revised procedures prior to utilizing the facilities, services, and programs of the ACADEMY. The undersigned further acknowledges and agrees that, due to the nature of the facilities, services, and programs offered by the ACADEMY, social distancing of 6 feet per person among children and their caregivers in a childcare setting is not possible. The undersigned fully understands and appreciates both the known and potential dangers of utilizing the facilities, services, and programs of the ACADEMY and acknowledges that use thereof by the undersigned and/or such participating children may, despite the ACADEMY's reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE ACADEMY FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO, OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY ON-SITE OR OFF-SITE PROGRAM AFFILIATED WITH THE ACADEMY, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

Accordingly, I hereby release the Academy, together with their directors, officers, employees, volunteers, and agents from all liability, claims, demands, losses, or damages arising out of Minor’s participation in the Program and I further agree that if, despite this release and waiver of liability agreement I, the Minor, or anyone on behalf of Minor or myself, makes a claim released in this agreement, I will indemnify and hold harmless each entity and person released herein from any and all litigation expenses, attorney fees, loss, liability, damage, or cost they may incur as the result of such claim.

Media Consent

I am the parent or legal guardian of (“Minor”) and hereby give Bronzeville Fencing Academy the absolute and irrevocable rights to use minors name, quotes and/or photos and images on the Internet (World Wide Web), in print publications, video and multimedia presentations, and/or for any purpose which may include, but not limited to display, public relations, marketing, or designs.

I understand that minors name and/or the images may be used for display or advertisement for the web site and or literature published. I hereby waive the right to inspect or approve the images prior to any form of usage. I understand that the images may be modified to be used as design elements. I am giving the Academy the right to use minors name and own the images and use them for any purposes without further approval from me. I am releasing all rights to any images.

Consent to Participate and Medical Waiver

I am the parent or legal guardian of (“Minor”) and I, the undersigned, do hereby acknowledge that my child is physically fit and in a condition to fully participate in all activities sponsored by the Bronzeville Fencing Academy and it is my wish for my child to participate in all activities. I represent that my child has no allergy, physical impairment, or any other disability and that my child is, not taking medication, which allergy, impairment, disability or medication would preclude me or my child from participating in this activity.

I further agree that in an emergency any Bronzeville Fencing Academy representative may transport my child to a hospital/medical facility and I authorize any physician or other medical personnel to carry out any diagnostic procedures or emergency care deemed necessary. I acknowledge that I am solely responsible for all medical and other costs arising out of bodily injury or any loss sustained through participation in this activity.



IN WITNESS WHEREOF, the undersigned certifies by signing below, that I am of legal age, 18 years of age or older and that I am the parent or legal guardian of the identified minor. I have read the above agreements and fully understand the terms, and have voluntarily entered into these agreements of my own free will based only upon the terms and conditions included herein. I understand and acknowledge that these waivers bind myself, my child, my heirs, administrators, executors, personal representatives, and assigns. Additionally, I acknowledge that all of the information provided on this student registration form is current and correct.