Martial Arts Class Registration
Fill out the form carefully and completely.
Student Name
First Name
Middle Name
Last Name
E-mail (parent email if under 18)
example@example.com
Phone Number ( parent phone number if under 18)
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Name of parent or guardian, if under 18 years old
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
I'm interested in the following classes: (Select all that you might attend.)
Morning Martial Arts Fitness
Adult Judo
Adult Brazilian Jiu-jitsu/Wrestling
Adult Karate
1:00 Judo/Karate/Wrestling
Beginning Judo and Karate (ages 3-5)
Kid's Judo
Kid's Karate
Open mat Saturday
Do you have any health concerns?
What interests you most about our dojo?
How did you hear about us?
I have read, understand and agree that
I, the student, or I, as a parent or legal guardian of (student’s entire name)_________________________________, I hereby consent to the aforementioned participation in martial arts and related activities with Mamoru Martial Arts, LLC. I recognize that there is a risk of injury involved in participating and I assume all risk for any injury sustained to the aforementioned participant and hold Mamoru Martial Arts, LLC, it officers, owners, agents, instructors, directors, and members harmless from any liability. I also certify that the aforementioned participant has health insurance or Medicaid. I also agree to allow any images, e.g., photographs, taken to be used by the company, e.g., for social media.
Signature
Date signed
-
Month
-
Day
Year
Date
Printed Name of Signing Parent or Guardian, if applicable
First Name
Last Name
I would like to Pay my $50 registration fee with: (Send to 319 Cul de Sac Dr. Rexburg, Idaho 83440)
Venmo @Alex-Greenfield-5
Check
Sign me up!
Should be Empty: