Rose City Self-Defense Registration

* Required Field Rose City Self-Defense Registration
RULES FOR REGISTRATION Who can register: We welcome all people who identify as a woman. Classes are open to ages 13 and above. Young women under 16 need to be accompanied by a participating adult woman. You can only register for open classes. You cannot register for classes marked as full with full waitlists. Check on our class schedules page for current class availability. Registration opens at 9 am on the first Tuesday of each month for classes the following month. (Example: Tuesday, June 6th at 9am for classes in July). If the first Tuesday is a holiday, registration will open on the first Wednesday instead. Registration date opening is denoted under each class heading. Registrations submitted prior to this date and time will not be processed. Registration submissions are time stamped, if you register before 9:00 am, your registration will not be taken
First Name*
Last Name*
OCTOBER CLASS FULL*
Age (required if under 18)
Primary Phone (if you do not have a phone number where it is safe to call or leave a message for you, leave this blank)
Phone Type	Phone Type Cell Home Work
Secondary phone (optional)
Phone Type	Phone Type Cell Home Work
Email address (if you do not have an email address where it is safe to send messages to you, leave this blank)
Physical limitations (if applicable) - please list any we should be aware of, and how we can best accommodate you in the class
Developmental/intellectual disabilities (if applicable) – let us know how we can best accommodate you in the class
Do you identify as a survivor of violence?
If you are a survivor, is there anything we should know or could do to help make class safe for you?
If you have any concerns, questions or comments for us, you can enter them here
Other people you are registering (Maximum 2) Classes are open to ages 13 and above. Young women under 16 need to be accompanied by a participating adult female.
Additional Person 1:
First Name
Last Name
Relationship to you
Age (required if under 18)
Primary phone (if different from yours, safe to leave a message)
Email address (if different from yours, safe to send messages)
Physical limitations (if applicable) - please list any we should be aware of, and how we can best accommodate her in the class
Developmental/intellectual disabilities (if applicable) – let us know how we can best accommodate her in the class
Does she identify as a survivor of violence?
If she is a survivor, is there anything we should know or could do to help make class safe for her?
Additional Person 2:
First Name
Last Name
Relationship to you
Age (required if under 18)
Primary phone (if different from yours, safe to leave a message)
Email address (if different from yours, safe to send messages)
Physical limitations (if applicable) - please list any we should be aware of, and how we can best accommodate her in the class
Developmental/intellectual disabilities (if applicable) – let us know how we can best accommodate her in the class
Does she identify as a survivor of violence?
If she is a survivor, is there anything we should know or could do to help make class safe for her?
Important Registering with this form does not guarantee a spot in the class! We process registrations in the order they are received. You will be contacted within 2-3 business days and informed if your registration was successful. .

The City of Portland, Oregon

Police Bureau

Sworn to protect. Dedicated to serve.