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
Mixed Martial Arts
Beginning Judo and Karate (ages 3-5)
Kid's Judo
Kid's Karate
Open mat Saturday
Muay Thai
Fencing
Tae Kwon Do
Other
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
Credit Card
Cash
Sign me up!
Should be Empty: