WPC` M:*~QqjJ)V}qmL X +y=׬hINas ܠlD-<4J8en@@icLJA8_Gy掆.D& o&V|AU]0$gWqw WbTY.`v^qa1`k.sB9PΧ~a&R5y+vy-Aѧ,SM~F#. 4N޳s}W`@07L6^̛(VZY 6"L +nۻ^F/n5%͹_gtB1`j !2u?sd"FȆ\7A<"Mnگ̫DaeZ~<.u?!$lj(DYYl(q6fv>GSu=⏀rTtcU\@ # U X %= 0:C U<} U0\ f a ^ + w7 4; O ^ m` fw ay f a f a f a f a f a f a faE''''''''''''''''''''''''''''''''''''''''''''''''''''' B )))))))))))))))))))))))))))))))))))))))))))) C Fhp officejet 4100 seriesT(,,,,T(0+r2'AZ@Microsoft Sans Serif Regular($USUS.,-O eAZ$Tahoma Regular+j AZDFranklin Gothic Medium RegularTABLE A;|1 S1:i+003|xUTABLE B0ETABLE C TABLE DTABLE ATABLE BxTABLE C TABLE DTABLE E ddd !USUS.,  _s&TRX3'Avery 6460 Removable 30 pX3' Letter3'Avery 6460 Removable 30 p3' Letter3'LetterT #`s&=#6 `> 6Ԁ#a>#7aԀCONCORDFENCINGCLUB F ЀMEMBERSHIPINFORMATION#a7E#ia #'i#<' 8 *Uddd Xdd Xdd X(#(#,dd ,dd ,dd , dd +  4(( dd4#J<#QOJ#QOOQ%#QIOOQName:   Age: , DOB: 5+%< dd 5StreetAddress:    Town/City:#aOQI#iaԀ#ai#QIOaState:#aOQI#iaԀ#ai#QIOaZIP:#aOQI,#ia - T  dd-#ais#QIOaHomePhone: C."2 dd ddCЀ C."2 dd ddCEmail: C."2 dd ddC 2("2 dd 2Parents/GuardiansNamesandContactInfo:    Father:  J  WorkPhone:CellPhone:  &  Mother:  b WorkPhone:CellPhone:>   #aOQI#ia*Ud ddd dd dd  dd U(#(#,dd ,dd ,dd ,dd +  4`` dd4#ai #QIOaMembershipStarts:#aOQI; #QIOaԀClass: 5+%dd 5Prev.Experience:  P Current_USFA_ԀMember:Yes&#aOQI #QIOaԀNo#aOQI #QIOaԀ&  , MembershipType:  , WeaponRatings:  h Foil:  h Epee:  h Sabre:  h RefereeRatings:  D Foil:  D Epee:  D Sabre:  D _USFCA_ԀCoaches   CollegeLevel  x! Foil:    Epee:     Sabre:   ! Current_USFCA_ԀMember:Yes&No&  #T" SportsSafetyTrainingorCPR:Year:  $# Other:&l!$   #aOQI #ia*Ud ddd dd dd dd U(#(#,xdd +  (#%(# #ai,#QIOaMyminorchildwillbetravelingto/from_CFC_Ԁwith: (B$& *lUddxdd xU(#(#l,xdd +  0+b&'+b& dd0ParentSignature:Date:2(&v+&( dd 2#aOQIT#a 򀀀 ,'( ЀCFC_MBRSHP_REG_08_2002REV.08_2004  X-()  .b)* #H##`HU#a`jaԀ CONCORDFENCINGCLUB  ЀMEDICALHISTORYQUESTIONNAIRE  L #aj#XP XaԀ( Must accompanyMembershipApplication) 8 *lUddxdd xU(#(#l,<dd ,<dd +  $ 0 0 $1.Isthereaphysicalconditionwhichmight <  preventyoufromfullyparticipatinginthe 8  physicalactivitiesofthisclass? 4   (x   D   *Udd<dd <<dd <U(#(#,<dd ,<dd +  PP 2.Doyouhaveaphysicalconditionwhich  needstobebroughttotheattentionofthe  instructor(i.e.asthma,diabetes,seizure  disorder,allergies,etc.)?       *Udd<dd <<dd <U(#(#,<dd ,<dd +   3.Areyoucurrentlyunderadoctorscare? $t    p  (x *Udd<dd <<dd <U(#(#,<dd ,<dd +  H H  4.Areyoutakingmedicationsof any kind ! (prescription,overthecounter, " naturopathic, asneeded,etc.)? #  Pleaselist.Usethebackofthisformif % " morespaceisneeded. &!#   (#%   & *Udd<dd <<dd <U(#(#,xdd +  0+'(+' dd0Name:Date:2(&,d') dd 2#a XXPj# "a ̀CFC_MED_QUEST_08_2002REV.08_2004 #a" #a -L)* #H##`H #a`ja 򀀀CONCORDFENCINGCLUB  ЀSAFETYPLEDGEANDASSUMPTIONOFRISK  L #aj!#XP XaԀ( Must accompanyMembershipApplication) 8 AU ) xdE xA  0 ________________________________________isenrolledinafencingclassat Concord  ? FencingClub .Allstudentsassumetherisksinherentinthesportoffencing.Asindividuals,  ; theycandomuchtolimitthisriskbythewaytheyconductthemselvesduringclass,  7  practiceandcompetition. 3  ̀ All studentsagreetothefollowingterms: +  ̀1.Iunderstandtherisksinvolvedinparticipatinginthisactivity. # ̀2.Iwillparticipatefullyinconditioningdrillstoprepareforthestressesofthesport.  ̀3.Iwillweartherequired,properlyfitted,protectiveequipment,andagreetonotify  Ѐtheinstructorifitisnotingoodrepair.  ̀4.Iagreetoobeyrulesandtospecificallyrefrainfromactionswhichmaycause  Ѐinjurytomyselforothers.  ̀5.IagreetoequipmyselfandpracticewithweaponsonlyafterIhavebeen  Ѐinstructedintheirproperuse.  ̀6.Iwillreportanyaccidentorinjurytothecourseinstructor,coachingstaff,or  Ѐcompetitionofficialsimmediately.   ̀7.Iwilltakeactiontocallanunsafesituationtotheattentionoftheinstructor, " Ѐcoachingstaff,orcompetitionofficialsimmediately. # ̀___________________________________________________________________ '"# ЀStudentSignatureDate {(#$ ̀_____________________________________________ s*%& ЀParentSignature o+&' #a XXP!#aa 򀀀_CFC_SFTY_PLDGE_08_2002_Ԁ 󀀀 REV.08_2004  g-() #`a ##``*#