ADULT RELEASE FORM - ABADÁ-Capoeira San Francisco

2025-2028 Adult Release Form

Pre-Registration is suggested for ALL classes, both online and in-person

First & Last Name *

Date of birth *

Home Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *This is the primary way we will communicate with you regarding our programs and important updates.

Phone Number *

Profession: *

Gender *How does the youth identify their gender?MaleFemalePrefer not to disclosePrefer to describe below

Please describe Gender Identities & Pronouns

How would you describe or identify yourself?If none of the above options fit your race/ethnicity. (Please specify)

Need Financial Assistance? *NO, thank you I can afford a regularly priced class and know my fees support essential operating costs for ACSF.Yes, I am experiencing financial hardship and need low-cost access to classes.

MEDICAL INFORMATION *Any physical/medical conditions that we should be aware of?

Have you ever done Capoeira before? *If yes, where? With whom? For how long?

Current Cord Level(if applicable)

Occupation / Hobbies *

Please specify below

We recommend that all staff and students get vaccinated against COVID-19

We strongly recommend that everyone stay up to date with their COVID-19 vaccinations. While masking is optional, we ask that all students remain mindful of ongoing health risks. If you experience any cold or flu-like symptoms, please stay home to help protect others.

RELEASE AND WAVE AGREEMENT (Read & Agree)

By checking the box below, I, the undersigned, agree to the following terms and conditions for my participation in activities with ABADÁ-Capoeira San Francisco (ACSF).

RELEASE OF LIABILITY *I do hereby release (for myself, my executors and administrators) and WAIVE any and all rights to claims for damages arising from any illness, accident or occurrence caused by or as a result of my participation or connection with ABADÁ-Capoeira SF, its instructors, agents, representatives and/or facilities. ABADÁ-Capoeira SF, its agents, instructors, representatives and facilities shall not be held responsible by me for the loss or theft of my or my child’s personal items. I declare that I have read and understood the foregoing statement and that I have either consulted a physician or voluntarily chosen not to consult a physician before, starting or during the course of this program. I have been warned that I must be in good health to participate in this program and I now declare that I am in good health.YESNO

Participant’s Signature *e-Signature Instructions: *Hold down your left mouse button and drag the cursor to add your signature from your computer or just sign using your finger on your smartphone or tablet.