Course Registration Form

Student Name*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Age*

Gender*

Address*

Street Address

CityProvince

Postal CodeCountry

Phone Number

Format: (000) 000-0000.

Mobile Number*

Format: (000) 000-0000.

E-mail*

used for newsletters, important notices, etc (NO SPAM)

Parent/Guardian (if student under 18 yrs old)

First NameLast NameRelationship to Student

Parent/Guardian (if student under 18 yrs old)

First NameLast NameRelationship to Student

EMERGENCY CONTACT (if parent/guardian cannot be reached)*

NamePhone Number

Medical/Physical Information and/or considerations pertinent to training, including any allergies (or type NA below if none): *

Buyer/Enrollee may cancel this agreement at any time, for any reason, by providing our office with written notice to that effect. In this case, any and all payments already submitted for the current month and/or other fees and/or purchases will not be refunded. (Note: tuition payments received in advance for future months or other terms will not be refunded, and they are not transferable to current or new members, however, they may or may not be applied to future tuition fees of/for Buyer/Enrollee)
Buyer/Enrollee may cancel this agreement at any time for reasons of substantial disability by providing us with a disability statement from a certified physician. (Note: any tuition payments received in advance for future months or other terms will not be refunded, however, may be applied to future months and/or transferred to current or new members)
Buyer/Enrollee understands that all fees indicated in this agreement are subject to applicable Provincial and Federal Taxes.
Buyer/Enrollee understands that tuition fees are due on or before the first day of the month(s) to which they apply. Payments received after the first day of the month will be subject to late charges. A dishonor charge will be applied to any payments not honored and will be applied to the Buyer/Enrollee’s membership account. Cash payments must be made before the first day of the month to which the payment applies.Credit Card payments will be processed on the first day of the month to which the payment applies. A service charge may be added to credit card tuition payments and late charges will be applied to buyer/enrollee whose credit card is not honored.
Due to the continuing nature of physical fitness and Martial Arts training, this agreement will berenewed automatically and will remain in effect indefinitely as monthly and/or course payments are received.
Buyer/Enrollee understands that he/she should take promotional rank examinations upon the recommendation of his/her instructor.
Buyer/Enrollee understands that uniforms, seminars, examinations, tournaments, provincial/national/international association fees, etc., are separate fees and are not included in the terms of this agreement.
Days, times and locations of classes are subject to change without notice. Classes may or may not be conducted on national, provincial or civic holidays, or on days in which a rented facility is made unavailable by the owner/landlord.
Fox TaeKwon-Do Schools and/or affiliated schools/clubs may, at any time, terminate this agreement/membership for just cause. In this case, all fees received in advance, for future tuition charges only, will be refunded, however, payments already received for the current month or other fees/purchases will not be refunded and are not transferable.
Buyer/Enrollee represents that he/she is in good health and suffers from no physical, mental or social impairments which would restrict his/her participation in the classes, examinations and other activities or jeopardize his/her, or another person’s health in any way from doing so.
Buyer/Enrollee realizes that there is a risk of injury involved in participating in TaeKwon-Do classes, examinations and other activities and voluntarily assumes the risk of accident, injury, damage, loss or other harm of any kind to his/her person or property as a result of participating in Fox TaeKwon-Do Schools and/or affiliated schools/clubs classes, examinations, tournaments and/or other activities or which may occur as a result of intentional or negligent acts caused by third persons.
Buyer/Enrollee agrees to hold Fox TaeKwon-Do Schools, affiliated schools/clubs, officers, agents, employees, instructors, fellow members and authorized guests harmless from all claims, liability, demands, suits, actions or other proceedings of any kind. Buyer/Enrollee irrevocably authorize
Fox TaeKwon-Do Schools, and those acting under their authority to copy, use, publish, for art, advertising, trade, or any other lawful purpose whatsoever, written submissions, photographic portraits, pictures or videotapes of them which they may be included in whole or in part. In consideration of training and education obtained,
Buyer/Enrollee agree that they will not, without the written permission of Fox TaeKwon-Do Schools, during the continuance of this agreement, and for a period of five (5) years following any termination of their association with the school, engage in teaching TaeKwon-Do or offer similar martial art, physical fitness or self-defense instruction within a ninety (90) kilometer radius of any school or club, operated by or affiliated with Fox TaeKwon-Do Schools. Undersigned Parent / Guardian also agrees to all provisions set forth in this agreement.

Are you a new or returning student?

New studentReturning student

Little Foxes (aged 4-5):

Children (aged 6-8) - please choose day or days you want to train:

Junior (aged 9-11) - please choose day or days you want to train:

Youth (aged 12-14) & Adults (15+) - please choose day or days you want to train:

Payment Options*

I agree to pay monthly tuition via eTransfer or Debit/CC on or before the 1st of the month and understand that a late fee will be applied to late payments.

*

Student Signature

Parent/Guardian Signature

(if student is under 18 years of age)

Date

Student Registration Form