TAEKWONDO Registration Form

Student's Information

1st Child's Name *

School *

Grade *

Date of Birth *

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Please Select Program *

Start Date

* 2nd Child's Name - if you register additional child

School

Grade

Date of Birth

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Please Select Program *

Start Date

Parent/Guardian Information

Name *

Address *

Cell Number *

E-mail *

Relationship *

Emergency Contact's Name

Relationship

Cell Number

K WHITE TIGERS MARTIAL ARTS Waivers & Agreements

PLEASE READ AND SIGN

Schedule and Teachers may change without notice.
By signing this registration I understand that I am agreeing to all policies and procedures for K WHITE TIGERS MARTIAL ARTS programs. This policies and procedures are listed on the back of this registration form. I also understand that my child is in agreement with the K WHITE TIGERS MARTIAL ARTS Rules and Regulations. My signature will also serve as permission for K WHITE TIGERS MARTIAL ARTS to transport my child to and from school.
I understand and accept that my or your child(ren) name, image, and/or quotation/testimonial/endorsement may appear in promotional and/or advertising materials, displays, feature or news stories, or news releases that may appear in print, on the World Wide Web, on television or radio, or in other media. Furthermore,
I understand and accept that this image and/or information shall constitute K WHITE TIGERS MARTIAL ARTS's property, solely and completely, and that it may be used in formats and media that are not produced, circulated, or otherwise controlled by K WHITE TIGERS MARTIAL ARTS.
I hereby grant permission for my child to be transported by the K WHITE TIGERS MARTIAL ARTS for activities. I understand that notice of such outings will be notified prior to any trip.
In case of medical emergency, I understand that every effort will be made to contact me or my emergency contact. If I or someone one the emergency form cannot be reached, I give the K WHITE TIGERS MARTIAL ARTS permission to secure the medical treatment necessary for my child; including hospitalization.
I understand that the K WHITE TIGERS MARTIAL ARTS assumes no responsibility for injuries or illnesses which my child may sustain as a result of his/her physical condition or resulting from his/her participation in any athletic activities, sports program, the use of any equipment, exercise or other activities. I expressly acknowledge on behalf of myself and my heirs that I assume the risk for any and all injuries and illness which may result from his/her participation in these activities and I hereby release and discharge the K WHITE TIGERS MARTIAL ARTS, its agents, servants, and employees from any and all claims for injury, illness, death, loss or damage which he/she may suffer as a result of his/her participation in these activities. I understand that the K WHITE TIGERS MARTIAL ARTS is not responsible for personal property lost or stolen while members and/or program participants are using K WHITE TIGERS MARTIAL ARTS facilities or on K WHITE TIGERS MARTIAL ARTS premises. According to the code of Virginia Law, K WHITE TIGERS MARTIAL ARTS after school program not allows children to enter and leave the premises without permission or supervision. This disclaimer also extends to the facilities used in the commission of the child care program.
I acknowledge the Waiver and accept the conditions set forth above and, am in sympathy with the Goals and purposes of the K WHITE TIGERS MARTIAL ARTS. I agree to adhere and abide by the policies of K WHITE TIGERS MARTIAL ARTS.

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 *

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