ADULT RELEASE FORM - ABADÁ-Capoeira San Francisco

2025-2027 Adult Release Form

Pre-Registration is suggested for ALL classes, both online and in-person

Name *

Gender *

I identify my gender as…

Male

Female

Prefer not to disclose

Prefer to describe below...

Address *

Country

City

State

ZIP code

Phone *

Email *

(Note: Email is the fastest, cheapest way for us to contact you. Please include an active current email. We will not sell or distribute your email or contact info!)

Birthdate *

(mm/dd/yy)

Do you have any physical/medical conditions that we should be aware of?

Please specify

Need Financial Assistance? *

No, thank you I can afford a regularly priced class and know my fees support essential operating costs for ACSF.

Yes, I am experiencing financial hardship and need low-cost access to classes.

Have you ever done Capoeira before? *

If so, with whom? For how long?

Current Cord Level

(if applicable)

Occupation / Hobbies *

IT IS SUGGESTED THAT ALL STAFF AND STUDENTS BE VACCINATED AGAINST COVID-19

We strongly recommend that everyone keep their Covid-19 vaccinations up to date. While masking is optional, we ask that all students remain mindful of the health risks. If you experience any cold or flu symptoms, please stay home to protect others.

Release and Waive Agreement *

I do hereby release (for myself, my executors and administrators) and WAIVE any and all rights to claims for damages arising from any illness, accident or occurrence caused by or as a result of my participation or connection with ABADÁ-Capoeira SF, its instructors, agents, representatives and/or facilities. ABADÁ-Capoeira SF, its agents, instructors, representatives and facilities shall not be held responsible by me for the loss or theft of my or my child’s personal items. I declare that I have read and understood the foregoing statement and that I have either consulted a physician or voluntarily chosen not to consult a physician before, starting or during the course of this program. I have been warned that I must be in good health to participate in this program and I now declare that I am in good health.

YES

Participant’s Signature *

(Full name)

Reset Signature

e-Signature Instructions:

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