Name * First Name Last Name How old is the participant? * Date of Birth MM DD YYYY SIGN UP FOR * Junior / Youth $165(6-13) - Includes unlimited classes. Junior / Youth $145(6-13) - Attending two times a week maximum. Junior / Youth $170(6-13) - for two months, only for those who train once a week. Adults and Teen (14+) $175 - Includes unlimited karate classes. Adults and Teen (14+) $155 - Attending two times a week maximum. Adults and Teen (14+) $190 - for two months, only for those who train once a week. Children (3-6): $125 - attending two times a week maximum Children (3-6): $155 - for two months, only for those who train once a week. Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent / Guardian Full Name First Name Last Name Parent / Guardian Phone Number (###) ### #### Contact in case of emergency * First Name Last Name Contact in case of emergency Phone Number (###) ### #### Participant's Occupation Student Employed Self-Employed Stay-Home Medical Condition which we should be aware of * How did you hear about us? * Family Member Social Media (Facebook, Instagram, Tik Tok) Website Google Search REFUND / CANCELLATION POLICY / MISSED CLASSES REFUND / CANCELLATION POLICY / MISSED CLASSES * Agree MEDIA CONSENT MEDIA CONSENT Agree Not Agree ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY * Agree Thank you!