Tony Yarber's Martial Arts Registration Form

Athlete Information

Athlete's Name

First NameLast Name

Birth date

DayMonthYear

MaleFemaleOther

White belt (beginner)Coloured beltBlack beltOther

Date

Parent/Guardian Information (if athlete is under 18)

Name

First NameLast Name

Mobile Number

eg 021Phone Number

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.

Membership

Private Session Days: Tuesdays, Thursday, Saturday30 min sessions. $35 per session or a monthly membership of $150. Track 1- Martial Arts and Self Defense Track 2- Martial Arts ONLY Track 3- Self Defense ONLYGroup Sessions (up to 4 per group): Tuesday, Thursday Saturday. 40 min sessions. $25 per session or monthly membership of $110 per month.

Cash - please make payment at beginning of class (no change)Cash App - $tdiditPayPal olemanyarber@gmail.com

Acknowledgement

I understand that all sports carry a risk of injury and that Tony Yarber's Martial Arts and Self Defense nor its partner, Relevant Ministries, Inc., are responsible for injuries or loss suffered as the result of participating in these activities.

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

Yarber's Martial Arts will give 30 days written notice of any fee increase.

Medical Authorization

In the event of an injury or medical emergency, I allow Yarber's Martial Arts or it's designee to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above.

I understand that all reasonable efforts will be made to contact the athlete’s parent and/or emergency contact if an injury or medical emergency occurs.

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.

Tony Yarber's Martial Arts and Self-Defense

Membership