Complete Your Membership

Who's joining?

Full legal name (member) * Date of birth * Is the member under 18? *

Contact & address

Email *

Phone *

Street address *

City *

State *

ZIP *

Parent / guardian details

Since the member is under 18, we need a parent or guardian's own contact info on file too.

Parent/guardian full name *

Relationship *

Parent/guardian email *

Parent/guardian phone *

Parent/guardian street address *

City *

State *

ZIP *

The member's own mailing address is different from the parent/guardian's above

Capoeira background

When did you start? (month/year, if you know)

Current cord

Graduation history — cords you've received + when (if you remember)

Liability waiver & release

Assumption of Risk, Release of Liability & Indemnification — Capoeira Brasil Palm Springs (CBPS).

1. Activity & risks

I understand that capoeira is a physical martial art involving movement, kicks, acrobatics, floor work, music, and partner interaction, and that participation carries inherent risks including but not limited to muscle strains, sprains, fractures, collisions, falls, and other injury. I voluntarily choose to participate with full knowledge of these risks.

2. Physical condition

I confirm that I (or my child) am physically able to participate, and that I am responsible for consulting a physician if I have any condition that could be affected by physical activity.

3. Release & waiver

In consideration of being allowed to participate, I release, waive, and discharge Capoeira Brasil Palm Springs, Grupo Capoeira Brasil, Mestre Mindinho (Raphael Cunha), its instructors, staff, and the facility owner from any and all liability, claims, or demands for injury, loss, or damage arising from my (or my child's) participation, to the fullest extent permitted by California law.

4. Indemnification

I agree to indemnify and hold harmless the parties above from any claims brought by or on behalf of me or my child related to participation.

5. Minors

If the member is under 18, I am their parent or legal guardian, I have authority to sign on their behalf, and this release binds me, the minor, and our heirs.

This is a legal agreement. By typing your name and checking the box below, you sign this waiver electronically and agree it has the same effect as a handwritten signature.

I have read and agree to the liability waiver and release above. * (Optional) I consent to CBPS using photos/video of classes and events for promotion.

Type your full name to sign *

Date

1. Activity & risks

2. Physical condition

3. Release & waiver

4. Indemnification

5. Minors