American Ninja Warrior Lock In...
 
Bring a Friend to the BBA Lock In! All students are welcome to bring a buddy to share in the fun!
 
April 28th 6:30pm to April 29th at 8:00 am
cost: $40 for the first child or $30 for additional family members or friends
 
Please fill out the registration form below.
Your buddy must have a parent/guardian register them on line to sign the waiver.
Space is limited, so register today!

April 28, 2017
April 27, 2017 8:00pm [Central Time]
6121 Odana Rd
Madison, WI 53719
Click for a larger map
INFO:   Please note that this form contains limited capacity items which are sold out. They are displayed grayed out and/or are not selectable.

Review Your Payment Information:

Registrant Fee: $0.00



Billing information


Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*BLACKBELTAMERICA 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
Please enter your full name in the space below.
 


Please click the button below to finalize your registration.



Registration inquiries:
Black Belt America
608-273-4111
info@blackbeltamerica.com
= required field
Oops! You do not have javascript enabled. This registration process depends on javascript to function correctly.

Please enable javascript in your browser and then reload this page.
Registrant   remove this registrant

I agree that I am 18 years or older or the Parent/Guardian of the registrant, agreeing to terms on his/her behalf. In consideration for my attendance and participation in this academy’s martial arts training, I, the student/parent, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve the academy, its management, assigned staff, and fellow students, from any liability resulting from personal injury or loss of personal belongings. I also hereby state that the students named above are physically fit to take the prescribed course of instruction and do so of their own free will for an agreed upon fee. I understand there is a no refund policy on any monies I will pay to this academy.

BOUNCE HOUSE WAIVER
I, the undersigned, understand and acknowledge that play on an amusement device entails both known and unknown risks including, but not limited to, physical injury from failing, slipping, crashing or colliding, emotional injury, paralysis, distress, damage or death to any participant. I hereby voluntarily and expressly release, indemnify, forever discharge and hold harmless Black Belt America from any and all liability, claims, demands, causes or rights of action whether personal to me or to a third party, which are in any way connected with participation in this activity, including those allegedly attributable to negligent acts or omissions. Should Black Belt America or anyone acting on behalf of Black Belt America be required to incur attorney’s fees and costs to enforce this agreement, I expressly agree to indemnify and hold Black Belt America harmless for all such fess and costs. In event I, the undersigned or any of my participants file a lawsuit against. Black Belt America, it is agreed to do so solely in the state of Wisconsin. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. In consideration of being permitted by Black Belt America to use its equipment and facilities, the undersigned and its participants agree to indemnify and hold harmless Black Belt America from any and all claims which are brought by the undersigned and/ or their participants and which are in any way connected with such use or participation. A set of Rules and Direction are either displayed on the bounce house/unit or have been provided to the undersigned which I agree to follow and utilize at all times during operation and use of the unit. I, the undersigned, acknowledge and certify that I have had sufficient opportunity to read the entire Rental Agreement and Acknowledgement of Risks, that I understand its content and that I execute it freely without duress of any kind and agree to the terms herein stated.

Check this box to indicate that you have read and agree to all of the above terms & conditions