Introduction/Orientation To Krav Maga Registration Form

All Beginner/Introductory Krav Maga Classes Are Taught At Our Woburn Location (165-E New Boston Street, Woburn, MA 01801). After completing this form and submitting it you will be redirected to a Paypal payment gateway.

If you would like a copy of this agreement for your records please email Liz at liz.kmy@bostonkravmaga.com.

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Date Of Birth (Must Be 18+) Date Of Birth (Must Be 18+) / MM / DD YYYY
Please Select The Class You Wish To Attend

Please Select The Class You Wish To Attend Saturday 5th April 2025 10:00 - 11:00 AM Saturday 26th April 2025 10:00 - 11:00 AM
Emergency Contact Details

Who We Should Contact In The Event Of An Emergency
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Contact Phone Contact Phone - ### - ### ####
What Is Your Relationship With Your Emergency Contact?
PARQ - Physical Activity Readiness Questionaire

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions listed below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly:
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? No
Do you feel pain in your chest when you do physical activity?

Do you feel pain in your chest when you do physical activity? No
In the past month, have you had chest pain when you were not doing physical activity?

In the past month, have you had chest pain when you were not doing physical activity? No
Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you lose your balance because of dizziness or do you ever lose consciousness? No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Do you have a bone or joint problem that could be made worse by a change in your physical activity? No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? No
Are You Pregnant?

Are You Pregnant? No
Do You Have Any Health Or Medical Issues That You Believe Would Prevent You From Taking This Class Or Any Other Classes At Krav Maga Yashir?

Do You Have Any Health Or Medical Issues That You Believe Would Prevent You From Taking This Class Or Any Other Classes At Krav Maga Yashir? No
Terms & Conditions

Please read the terms and conditions of training at Krav Maga Yashir and sign in the box below.
In consideration of being allowed to attend Krav Maga classes & seminars, I acknowledge that Krav Maga is a physical activity and that participation may result in serious injury including death, and or other damage, due not only to my actions, inaction or negligence, but also to that of others associated with and or present at these or other classes & seminars. Furthermore, I acknowledge that there may be risks not known to me and or not reasonably foreseeable at this time. I personally, totally and completely assume all risks involved or in any way related to my participation in this Krav Maga class whether known or unknown to me at the present time. I also acknowledge and understand that the training I receive at Krav Maga Yashir does not constitute specific or legal advice of any kind. Participation in this Krav Maga class is voluntary and entirely of my own free will. I hereby represent and certify that I am in good physical condition, and have no diseases, injuries or other physical or mental conditions that would impair my ability to participate in the Krav Maga class. I, my heirs, executors and successors hereby waive and claim of accidental and or negligent tort damages or injury against Krav Maga Yashir Boston and its instructors. I also certify that I am covered by a medical insurance plan and if asked will present the needed information for approval to attend and participate in one of the Krav Maga Yashir Boston classes & seminars. Any monies paid for classes & seminars and courses are non-refundable, however the monetary amount may be, at the discretion of Krav Maga Yashir, applied to other products and services that may be offered. Whilst training on the premises of Krav Maga Yashir, and/or at events and seminars organized or arranged by Krav Maga Yashir, I acknowledge that photographs or video may be taken, and I give Krav Maga Yashir permission to use these photographs and video containing my image for any and all purposes. By signing below, I guarantee that in accordance with the rules of Krav Maga Yashir, I will not make any recording, in any format: video, audio, or photography, within the Krav Maga Yashir facility. I further understand that by accessing content on the KMY Online site I am agreeing to the Terms & Conditions set forth on the site.

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Introduction/Orientation To Krav Maga Registration Form

Introduction/Orientation To Krav Maga Registration Form

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Emergency Contact Details

PARQ - Physical Activity Readiness Questionaire

Terms & Conditions

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