PFC REGISTRATION FORM

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Portland Fencing Center
1037 Forest Avenue
Portland, Maine 04102
207-808-8160

Lessons and classes not reserved until payment, registration, PFC waiver, proof of vaccination and USA Fencing non-competitive membership submitted.

NAME OF FENCER *

ADDRESS *

CITY/TOWN *

STATE/ZIP *

EMAIL ADDRESS *

PREFERRED PHONE *

BIRTH DATE MM/DD/YYYY *

HAND *

Right

Left

Please list any medical or physical conditions that might prevent full participation or which should be brought to instructors attention. *

Would you allow Portland Fencing Center to use images and video of registering Fencer for PFC website, social media, news, and promotional material? *

YES

Name of applicant or parent if child is under 18 *

Full name

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