Guest Registration and Waiver
The below information is required prior to participating in the first class.

Capoeira Camará does NOT share any of the below information or emails with anyone or any other companies.
We also do NOT send out advertisements via email unless you choose to opt-in. The information you provide is strictly confidential.

Location to attend *
Experience Level *
Starting Month *
First Name of Participant *
Your answer
Last Name of Participant *
Your answer
Name of Parent / Guardian (if participant is under 18)
Your answer
Address *
Your answer
City *
Your answer
Province / State *
Your answer
Postal Code / ZIP Code *
Your answer
Cell / Home Phone # *
Your answer
E-mail *
Your answer
Age *
Emergency Contact Name (First & Last) *
Your answer
Emergency Contact Phone # *
Your answer
Is this your first visit to Capoeira Camará? *
How did you hear of our classes? *
Your answer
Did / Do you belong to another Fitness / Martial Arts Club? *
If "Yes" which club?
Your answer
Please explain your health and fitness goals
Your answer
Additional Information
Your answer
Waiver
I hereby release and hold harmless Capoeira Camará, its agents, officers and employees and any affiliated companies from any liability with respect to any injury of any nature suffered by me or to my property arising out of or in any way connected with my, or my children's participation in any capoeira or such related activity from the below date onward
*
Date *
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