Workshop Information Date: Saturday, May 30
Time: 11:00 AM - 12:00 PM
Location: Prime Martial Arts, 200 Nazareth Pike, Bethlehem, PA 18020
Cost: FREE
Hosted By: Rianna's Voice
Teen Participant Information Anything we should know about the teen before the workshop?
Examples: anxiety concerns, physical limitations, injury history, accommodations, or anything else that would help us support the participant.
Parent/Guardian Information Parent/Guardian Full Name(Required)
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Emergency Contact Information Is the parent/guardian listed above also the emergency contact?(Required) Emergency Contact Full Name(Required)
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Medical and Safety Information Does the participant have any medical conditions, injuries, allergies, or physical limitations we should be aware of?(Required) Please explain any medical conditions, injuries, allergies, or physical limitations.(Required)
Is the participant currently able to safely engage in light to moderate physical activity?(Required) If no, please explain.(Required)
Workshop Acknowledgment Please confirm the following.(Required) All checkboxes must be checked in order to submit the registration form.
Liability Waiver and Release WAIVER, RELEASE OF LIABILITY, ASSUMPTIN OF RISK, AND MEDICAL AUTHORIZATION I am the parent or guardian of the minor participant named in this registration form. I give permission for my child to participate in the Rianna's Voice Teen Self-Defense Workshop hosted at Prime Martial Arts on Saturday, May 30 from 11:00 AM to 12:00 PM.I understand that participation in a self-defense workshop involves physical activity, including but not limited to stretching, movement, stance work, drills, demonstrations, and partner-based instruction. I understand that physical activity carries inherent risks, including but not limited to slips, falls, strains, sprains, bruises, contact-related injuries, aggravation of pre-existing conditions, and other unforeseen injuries.I certify that, to the best of my knowledge, my child is physically able to participate in this activity, or I have fully disclosed any medical condition, injury, restriction, allergy, or other concern that may affect participation. I understand that it is my responsibility to consult with a physician if I have any questions regarding my child's fitness to participate.On behalf of myself and the minor participant, I voluntarily assume all risks associated with participation in this workshop.In consideration of being allowed to participate, I, on behalf of myself, the minor participant, and our heirs, assigns, personal representatives, and next of kin, hereby release, waive, discharge, and hold harmless Rianna's Voice, Prime Martial Arts, their officers, directors, employees, volunteers, instructors, agents, representatives, affiliates, successors, and assigns from and against any and all claims, demands, damages, rights of action, or liability, whether known or unknown, arising out of or related to the minor participant's attendance at or participation in this workshop, including but not limited to claims for personal injury, illness, property damage, or loss, except to the extent caused by gross negligence or willful misconduct where such release is prohibited by law.I authorize Rianna's Voice, Prime Martial Arts, event staff, and emergency personnel to obtain emergency medical treatment for the minor participant if I cannot be reached immediately and if such treatment is deemed necessary in their reasonable judgment. I understand that I am responsible for any medical expenses incurred as a result of such treatment.I understand that this workshop is educational in nature and is intended to provide general self-defense awareness and instruction. No guarantees or warranties are made regarding outcomes, effectiveness, or prevention of harm.I have read this waiver carefully, understand its contents, and agree to its terms voluntarily and without reservation.
Consent and Agreement I am the parent/legal guardian of the participant, I have read and understand the waiver above, and I agree to its terms.
Photo and Video Permission May Rianna's Voice use photos or videos of the participant from this event for educational, promotional, website, newsletter, or social media purposes? Additional photo/video notes
Optional. Use this space if there are any limitations or concerns you want us to know about.
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