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PORTLAND FENCING CENTER NOVICE REGISTRATION FORM
IMPORTANT INFORMATION
Placement is not reserved until payment is received.

WE ACCEPT CREDIT CARDS ON OUR WEBSITE THROUGH PAYPAL.

IF PAYING BY CHECK PLEASE FORWARD PAYMENT:
Portland Fencing Center
1037 Forest Avenue
Portland, Maine 04102
207-808-8160



Holiday Schedule Changes
Closed Thursday Nov 28th (Thanksgiving Day)
Closed Tuesday Dec 24th - Wednesday Jan 1st (Holiday Break)
** All intro schedules accommodate these closings
NAME OF FENCER *
Your answer
SELECT ONE OF THE FOLLOWING *
Required
ADDRESS *
Your answer
CITY/TOWN *
Your answer
STATE/ZIP *
Your answer
EMAIL ADDRESS *
Your answer
EMAIL ADDRESS (2)
Your answer
PREFERRED PHONE *
Your answer
MOBILE *
SECONDARY PHONE *
Your answer
MOBILE *
BIRTH DATE MM/DD/YYYY *
Your answer
SCHOOL (OR HOME SCHOOL) CURRENTLY ATTENDING AND GRADE *
Your answer
HAND *
Please list any medical or physical conditions that might prevent full participation or which should be brought to instructors attention. *
Your answer
Would you allow Portland Fencing Center to use images and video of registering Fencer for PFC website, social media, news, and promotional material? *
Waiver and Release of Liability and Indemnity
– Electronic Signature Required: In consideration of my or my child’s participation in any sponsored activity, instruction, practice, competition, use of equipment, use of facility, or any activity of any type of the Portland Fencing Center and/or the United States Fencing Association; a) I fully understand and am aware of and appreciate the risks and dangers, including the risk of serious bodily injury and death;
b) I hereby release, discharge, covenant and agree not to sue, and agree to indemnify and save and hold harmless, on behalf of myself, my child, my heirs, and my personal representatives, the Portland Fencing Center, the United States Fencing Association, their respective administrators, directors, agents, officers, volunteers, coaches, instructors, and employees, other participants, any sponsors, advertisers and owners and lessors of premises on which any activity takes place (each considered one of the “Releasees”) from all liability, claims, demands, actions at law or equity, losses, or damages on my account or my child’s account caused or alleged to be caused in whole or in part by the negligence or other fault of any kind of the “Releasees”; c) I agree to indemnify, save and hold harmless each of the “Releasees” from any claims, demands or actions at law or equity that may subsequently be brought on my behalf or on my child’s behalf to recover for injuries or damages, including any litigation expenses or attorney fees, and agree to indemnify, save and hold harmless each of the releases from any litigation expenses, attorney fees, loss liability, damage or cost that may occur as a result of any claim brought by myself or my child; d) I understand this agreement and understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance.
-PAYMENT REQUIRED UPON CONFIRMATION OF ENROLLMENT-
-CHECK OR CASH-
-NO CREDIT CARDS-NO REFUNDS

I have reviewed, understand, and agree to comply with the above policy. *
Name of applicant or parent if child is under 18 *
Full name
Your answer
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