Native American Self-Awareness Institute

Application Form

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Send with your payment to: NASAI, 2422 N. 72nd Pl., Scottsdale Az 85257
(480) 970-8811

 
Course Name
# of days
Cost:
Name (Last, First, Middle Initial)
Home Address (Number, Street)
City
State
Zip
Date of Birth
Age
Phone #
Male
Female
Occupation/Employer
Emergency Contact
Emergency Phone # 
Cell #/ Pager #
Relationship
Where did you hear about us?
Health Problems

Waiver and Release

In all classes, demonstrations, and excursions conducted by Native American Self-Awareness Institute, reasonable care is taken to prevent serious injuries and to minimize accidents. The STUDENT states that he/she is fully aware that hiking, climbing, survival, tracking, awareness, and philosophy training, even under the safest conditions possible may be dangerous, and the STUDENT hereby agrees to accept full responsibility and assume all risks, including those caused by acts of God, injury, death, and/or loss to his/her person and/or property knowingly and voluntarily. The STUDENT agrees to obey the rules and regulations that Native American Self-Awareness Institute puts into effect to minimize these risks.

The STUDENT knowingly, voluntarily, and irrevocably waives any and all past, present, and/or future injuries, death, or loss, including those caused by acts of God, received while participating in activities conducted byNative American Self-Awareness Institute as a student, participant, spectator, and/or visitor, or in any other manner or form, taking part in the exercises, practices, excursions, and/or demonstrations of said hiking, climbing,survival, tracking, awareness, and philosophy training. The STUDENT certifies that he/she is physically capable to participate in the said survival, tracking, awareness, and philosophy-training program despite the rigors and dangers inherent in such undertaking. The STUDENT accepts all responsibility for any injury, death, and/or loss to his/her person and/or property, including by acts of God, for the rigors and dangers inherent in this undertaking.

Application Form cont.

My signature below indicates my acceptance of these terms and my desire to participate in Native American Self-Awareness Institute. I acknowledge that should I fail to notify NASAI of my cancellation at least 72 hours prior to the first day of class, my signature conveys authority to NASAI to keep the total of my deposit. I also acknowledge that should I cancel, only 50%of the NON_REFUNDABLE deposit is transferable.

NOTE: Prices and policies quoted are valid for 90 days from the receipt of catalog and are subject to change without notice.

Signature of Applicant Date
 

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