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Women’s Wellness Weekend Registration
Melissa Church
2022-03-11T20:23:22-05:00
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Name
Phone number
E-mail
Mailing Address
Emergency Contact Name and number
Dates to Attend
(Please select all or individual dates.)
Friday, June 17th
Saturday, June 18th
Sunday, June 19th
Would you like single or double occupancy?
Please check one.
Single Room
Double Room
N/A
Linens
Which do you Prefer? Please check one.
Bring your own sheets, pillowcases & towels.
Provided by facility. Add $15 to invoice.
Optional: Would you be interested in a massage during the weekend? Additional charges would apply for the therapist.
optional
no
15 minutes
30 minutes
Do you have any dietary restrictions or allergies?
Please indicate your general health or any health concerns that we should be made aware of during your stay.
What do you hope to gain from this weekend?
Previous Martial Arts or fitness experience?
How did you find out about about this Women's Wellness Weekend?
Would you like to receive our e-mail newsletter?
Yes
No
Payment
e-transfer (to: info@templeknights.com)
Visa or Mastercard (add 3.4% surcharge)
cash or debit (in-person)
cheque (payable to Temple Knights)
Paypal
Please indicate whether you wish to pay the full amount or a 50% deposit.
payment in full
50% deposit
Waiver: By signing this registration form I certify that the above information is correct. As a participant I acknowledge that Temple Knights and their representatives shall in no form be liable or responsible for injury, bodily harm occurring to me during this weekend and that such risks shall be borne by me voluntarily.
Choose
I agree when I attend my first class:
Date
(optional)
Signature
(optional)
Submit Form
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