Martial Arts Course Registration Form

TEAM JAX Taekwondo Registration

Affiliate of Jacksonville Arts and Music School (JAMS)
Student Information
Student's Name*

First NameLast Name
Birth date*

DayMonthYear
Gender*

MaleFemaleOther
Current level*

White belt (beginner)Coloured beltBlack beltOther
Date

MonthDayYear
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 student have asthma, allergies, or any other medical condition? If yes, please describe.
Payment
Payment option

Cash/Debit or Credit Card - please make payment at beginning of classOnline payment/Square Invoice
Acknowledgement I understand that all martial arts activity carry a risk of injury and that the Jacksonville Arts and Music School (JAMS), Team JAX Taekwondo is not responsible for injuries or loss suffered as the result of participating in these activities. From time to time Jacksonville Arts and Music School (JAMS), Team JAX Taekwondo of our students/athletes, coaches, and supporters online. I will let Jacksonville Arts and Music School (JAMS), Team JAX Taekwondo know by email if I do not consent to my or my child’s photos being shared. Jacksonville Arts and Music School (JAMS), Team JAX Taekwondo will give 30 days written notice of any fee increase.
Medical Authorization In the event of an injury or medical emergency, I allow Jacksonville Arts and Music School (JAMS), Team JAX Taekwondo to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the student 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.
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TEAM JAX Taekwondo Registration