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MasterYusBootCamp

RegistrationForm
Joinusforthis2hourfatburning,musclebuilding,oneofakindworkout!
Date:September22,2013
Time:9:00am11:00am
Location:MasterYusBlackBeltInstitute,713EastMainSt.inBridgewater,NJ
**Pleasebringsneakers!Wewillbeworkingoutindoorsandoutside!**
Cost:$39.00includesaTShirtandWater!
PleasecompletetheregistrationformbelowandreturnittoMasterYuorstaffmemberbefore
September20th.Ifyouhaveanyquestions,donothesitatetoask!
Name:________________________________________________________________
(PleasePrint)
TShirtSize(pleasecircle): S
M
L
XL
EmailAddress:_________________________________________________________
PhoneNumber:_________________________________________________________
EmergencyContactName:________________________________________________
EmergencyContactPhone#:______________________________________________
Pleaseidentifyanymedicalconditions:_______________________________________
______________________________________________________________________________
______________________________________________________________
InexchangeforpermissiontoparticipateinMasterYusBootCamp,Iherebygrantthefollowing
releasefromliabilityandnegligence:IreleaseandholdharmlessYusBlackBeltInstituteand
CardioKickboxingCenter,itsofficers,directors,agents,employees,instructors,andlandlords
fromanyandallliabilityforinjurytomypersonorpropertycausedinanymannerbymy
participationinMasterYusBootCampon9/22/13.

Signature:_____________________________________________________________
GuardianSignature(ifunder18yrsold):_____________________________________
Date:___________________________________

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