SIMBA DOJO MEMBERSHIP

SIMBA DOJO

MEMBERSHIP APPLICATION
Full Name of Student *

First Name Last Name
Take Photo *
Birthdate *

Month Day Year
Date
Age *
Sex
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Verrado Resident *
Email *
example@example.com
Student Phone *
Other Contact Relationship *
Name *
Email
example@example.com
Phone *
Cell Phone
Please enter a valid phone number.
SIMBA DOJO MEMBERSHIP AGREEMENT
AS A CONDITION OF MEMBERSHIP TO SIMBA DOJO SHOTOKAN KARATE CLUB AND BEFORE ENGAGING IN ANY ACTIVITIES WITH THIS CLUB I AGREE TO ABIDE BY THE FOLLOWING TERMS AND CONDITIONS:
I agree to adhere to and sign all waivers of liability.

I understand that if I choose to participate in any activities with Simba Dojo, I do so at my own risk.

I also agree not to hold the club administrators, instructors, or other students liable for any injury or sickness that I may obtain.

I understand that membership fees must be paid at the beginning of each month.

I understand that I cannot attend class if I am not feeling well and am able to return only when safe to do so.

I will abide by all state and federal laws as well as the rules set by The Center on Main.

I also agree to follow the Dojo kun or rules of conduct while engaging in any club activity or using the facility.

I understand that my club membership can be terminated at any time by myself or its administrators.
Student Signature *

Clear
Date *

Month Day Year
Date
Parent / Guardian Signature (if minor)

Clear
Date Parent or Guardian Signed

Month Day Year
Date
Geo Stamp
Please verify that you are human *
Should be Empty:

SIMBA DOJO

SIMBA DOJO MEMBERSHIP AGREEMENT

AS A CONDITION OF MEMBERSHIP TO SIMBA DOJO SHOTOKAN KARATE CLUB AND BEFORE ENGAGING IN ANY ACTIVITIES WITH THIS CLUB I AGREE TO ABIDE BY THE FOLLOWING TERMS AND CONDITIONS: