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New Registration Form

Registrant First Name

Registrant Last Name

Date of Birth

Phone Number

Address

Email

Does the fencer have prior fencing experience? If yes, please describe:

Please indicate if fencer has any physical limitations or medical conditions, which could influence training.

Parent / Guardian Name (if applicable)

Parent/Guardian Name

School Information (if applicable)

School Name

School Grade

Emergency Contact Information

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

How did you hear about us?

What session(s) are you registering for? * Required

FREE Trial Lesson

Youth Group Class Friday 6-7pm (Suggested for ages 8-11)

Youth Group Class Friday 7-8pm (Suggested for ages 10-13)

High School Group Class Friday 8-9pm

Adult Group Class Friday 8-9pm (Ages 18+)

High School Épée Group Class Saturday 10-11am

Mini Musketeers Saturday 11:30am-12:30pm (Group Class Ages 5-7)

Youth Group Class Saturday 12:30-1:30pm (Suggested for ages 8-13)

Individual Lesson

Conditioning Class

Open Fencing

CONTACT INFO

BladeRunnerFencing@gmail.com

663 Manor Road

(St. John's Lutheran Gym)

Staten Island, NY 10314

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