K12 Karate Club Registration Form

K12 Karate Club Registration Form

Registration Form
Athlete Information
Athlete's Name

First NameLast Name
Birth date

DayMonthYear
Gender

MaleFemaleOther
Current level

White belt (beginner)Coloured beltBlack beltOther
Date

MonthDayYear
Date
Height
Weight
Age
Parent/Guardian Information (if athlete is under 18)
Name

First NameLast Name
Mobile Number

eg 021Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Alternative Emergency Contact
Emergency Contact's Name

First NameLast Name
Mobile Number

eg 021Phone Number
Does the athlete have asthma, allergies, or any other medical condition? If yes, please describe.
Acknowledgement

I understand that all sports carry a risk of injury and that Team Ascension Martial Arts is not responsible for injuries or loss suffered as the result of participating in these activities.

From time to time Team Ascension Martial Arts will post photographs of our athletes, coaches, and supporters online. I will let them know by email if I do not consent to my or my child’s photos being shared.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

Clear
Should be Empty: