ZAKURDAYEV SCHOOL OF WOODCARVING
8410 Bustleton Ave. Suite #2, Philadelphia PA 19152

REGISTRATION INSTRUCTIONS AND FORM

Payment is due in full at time of registration. As others will be turned away in order to reserve
a place for you among the 6 students in any given class, your registration fee becomes
nonrefundable within 35 days prior to the start date of the course in which you are enrolled.
Cancellations before this 35 day period are refunded in full, less a $40 administrative processing
fee for locating another to fill your spot.

Waiver of Liability. Despite the fact that there will be a very heavy emphasis on safety in all
aspects of your activities at Zakurdayev School of Woodcarving, and your instruction with Leonid
Zakurdayev, it should be understood by the enrollee that woodworking can be a dangerous
activity. Each enrollee must be willing to assume 100% of the risk of personal injury as a result of
activities engaged in and/or related to enrollment in any of the woodworking classes offered.
Students unwilling to assume this personal responsibility will not be accepted

Course No.________

Name ________________________ Home phone (_____)___________

Address____________________________

City/St/Zip_________________________________

Work Phone (______) ______________ e-mail _______________________

Are you an adult over the age of 18? Yes ___ No _____

Your occupation _____________________

Do you have any limitations or disabilities which would affect your participation in any
particular woodworking class?
Yes_________ No________
(If you answer “yes”, please call Leon or Svetlana Zakurdayev at 215-673-6773 prior to
enrollment to discuss any special conditions.)

Tuition and materials totals _____.

Return this completed registration form, your Waiver of Liability (page 2 of this document) and
your tuition check to the address below.

Leon Zakurdayev
9921 Bustleton Ave., #O-2
Philadelphia, PA 19115

Questions or concerns, call Leon or Svetlana at 215-673-6773 or email at
info@zakurdayevfinewoodcarving.com

 

ZAKURDAYEV SCHOOL OF WOODCARVING
8410 Bustleton Ave. Suite #2, Philadelphia PA 19152

Waiver and Release of Liability

I, the undersigned individual, have applied for enrollment in a woodcarving course to be
conducted by Leonid Zakurdayev. I understand that woodworking can be a dangerous activity
which could result in damage to my property, or serious injury to me. As an Enrollee, I completely
and fully assume 100% of the risk of damage or injury as a result of activities engaged in and/or
related to enrollment and participation in any woodcarving course at Zakurdayev School of
Woodcarving.

In consideration of the permission extended to me to enroll in a course conducted by Leonid
Zakurdayev, and with intent to be legally bound, I hereby assume full responsibility for all injury or
damage to me or my property, including that caused by the negligence of others, arising from or
related in any way to participation in said course, and for myself, my heirs, executors,
administrators and assigns forever release Leonid Zakurdayev , its shareholders, officers,
directors, agents, employees, teachers and landlords from all liability, claims, demands, actions,
causes or action, of whatever type or nature, for any injury to my person (including death) or my
property, arising from or related in any way to enrollment or participation in said course.

Signature of Enrollee ___________________ date _________________________

Signature of Witness ___________________ date _________________________

Print name of Enrollee _____________________

Print name of Witness ______________________