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Women's Self Defense One-Day Class Registration

  1. Woodland Police Coin Image
  2. Women's Self Defense One-Day Class Registration
    Please complete and submit the registration form. Make sure to indicate the class date for attendance. Registrations are processed on a first come, first serve basis. Classes fill up quick, so registering early is important.
  3. Please enter the date of the Women's Self Defense Class as advertised by Woodland PD.
  4. Emergency Contact Information
  5. Emergency Contact
  6. Emergency Contact
  7. Emergency Contact
  8. Emergency Contact
  9. How did you hear about this class?*
    Please select all that apply:
  10. Waiver of Liability, Medical Release, and Indemnification for Minor and Adult Participant
    In consideration for myself and my minor child(ren) being permitted by the City to participate in the above listed activity each of us hereby waives, releases, and discharges any and all claims for damages for personal injury, death, or property damage me or my minor child(ren) may sustain or which may occur as a result of my or my minor child(ren)’s participation in said activity, I understand and agree that:
  11. 1. This release is intended to discharge in advance the said City (its officers, employees, agents or partners) from and against any and all liability arising out of or connected in any way with the participation of me or my minor child(ren) in said activity, even though that liability may arise out of negligence or carelessness on the part of said City (or its officers, employees, agents or partners). *
  12. 2. Each of us understands that the described activity may be of a hazardous nature and/or include physical and/or strenuous exercise or activity; *
  13. 3. That serious accidents occasionally occur during the above-described activity; and that participants in the described activity occasionally sustain mortal or personal injuries and/or property damages as a consequence thereof; I also recognize the risk or a concussion in a program to the said minor or myself and acknowledge the City’s head injury information sheet prior to participation in the program listed above by myself or my minor child(ren). *
  14. 4. Knowing the risks involved, nevertheless each of us agrees to assume all risks of injury and to release and hold harmless the said City (its officers, employees, agents, or partners) who through negligence or carelessness might otherwise be liable to me or my minor child(ren). It is further understood that this waiver, release and assumption of risk is to be binding on the heirs and assigns of the undersigned. *
  15. 5. Each of us further agrees to indemnify and to hold harmless the said City (its officers, employees, agents, or partners) free and harmless of any loss, liability, damage, cost of expense which they may incur as a result of any injury and/or property which myself or my minor child(ren) may sustain while participating in said activity. *
  16. 6. I certify that I have custody or am the legal guardian of said minor by court order.*
  17. 7. I fully agree to reimburse or make good any loss or damage cost that said City (its officers, employees, agents, or partners) may have to pay if any litigation arises on account of any claim made by myself or my minor child(ren) or by anyone on behalf of said minor. *
  18. 8. I agree that in the event said minor requires medical or surgical treatment while under the supervision of City, and the City is unable to reach me to authorize consent, City may authorize treatment, I further agree that City may provide limited non-invasive medical services (including, but not limited to, application of bandages or ice/heat) to said minor without requiring my authorization.*
  19. 9. Activities are not child care as defined by the State of California. *
  20. 10. I give consent to the City of Woodland and Woodland Police Department to photograph or videotape me or my minor child(ren). I understand the pictures or video may be included in the promotion of all City Programs.*
  21. I agree to accept and abide by the rules and regulations of the City of Woodland.*
    I have carefully read this Waiver of Liability, Medical Release, and Indemnification Agreement, and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the said City and I sign it of my free will.
  22. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  23. REQUIRED - If Participant is a minor.
    You will be contacted via email as to the outcome of your submitted registration. Registrations are accepted on a first come, first serve basis. There is limited openings for each class and not everyone who submits a registration will be accepted. Please keep an eye out for a confirmation email from If you have questions, please contact Trista at the email above or by calling 530-661-7865.
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