2020/2021 After School Karate Registration

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least two person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the studio/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact & Authorized Pick-Up #1
Full Name*

First NameLast Name
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child*
Emergency Contact & Authorized Pick-Up #2
Full Name*

First NameLast Name
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Relationship to Child*
Authorized Pick-Up #3
Full Name

First NameLast Name
Primary Phone Number
Format: (000) 000-0000.
Authorized Pick-Up #4
Full Name

First NameLast Name
Primary Phone Number
Format: (000) 000-0000.
Authorized Pick-Up #5
Full Name

First NameLast Name
Primary Phone Number
Format: (000) 000-0000.
AUTHORIZED PICK UP POLICY: Only the people listed above may pick up your child from after school. No exceptions are made for family members without advanced written notice prior to pick up.*
Type initials above to consent
Please provide the names of persons who are UNAUTHORIZED to pick up your child: (These people are specifically NOT allowed to pick up your after schooler)
List the FIRST and LAST names of all persons unauthorized to pick up your child.

Classes, Snacks, Payment, Policies & Procedures

Karate International San Antonio referred to as "KISA"
MARTIAL ARTS CLASSES: After Schoolers who are enrolled in a membership to train at Karate International San Antonio in our martial arts classes will be reminded to change and escorted to the mat for their class, as long as that class time is prior to 6:00pm. After Schoolers will be checked out as "training" and parents will be sent a notification.*
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SNACKS: It is suggested that each child bring a healthy snack each day. You may bring as much as you like (non-refrigerated) in advance and store it at KISA; however, we do NOT have the ability to provide snacks or food of any kind. *
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PICK UP: All scheduled activities will end at 6:00pm. STATE REGULATIONS require that your child be picked up no later than 6:15pm. We understand that you may encounter emergencies or unforeseen traffic problems, and we will attempt to work with you when that happens. If you are going to be late, please call us as soon as you know. Students who are not picked up from the After School Program by 6:15pm will be charged $5 for each additional 15 minutes.*
Type initials above to consent
PAYMENT POLICIES: All payments for the month are due by the 1st of each month unless other payment arrangements have been made with a managing staff member. Please understand that monthly tuition is based on a yearly school calendar of NISD. As a result, our tuition is calculated based on a rate of $80.27 per week for all 37 weeks and then divided equally over 9 month period (August 1st, September 1st, October 1st, November 1st, December 1st, January 1st, February 1st, March 1st, April 1st, and May 1st) to provide you with a consistent monthly base rate. Rather than charge you weekly with varying tuition payments each month, we prefer to charge you the same base rate each month regardless of how many weeks your child attends school. At the end of the school year, you will have still paid the same amount for after school care. There will be a $25 service charge for any returned E-checks (EFT/ACH) payments. If your payment will not authorize we will notify you, and you will have 48 hours from our notice to bring us full payment. If you fail to do so, your child's membership will be suspended and we will not pick-up your child from school the following Monday.*
Type initials above to consent
Please select the days during the week for after school service. (Please note that once your days are picked, we are unable to switch unless we have an opening and 14 day notice is given prior to the desired switch.) Select ALL that apply:*

MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY
Please select a monthly tuition option (Price will vary for additional children):*
I hereby authorize Karate International San Antonio to initiate debt entries for after school services on the first (1st) of each month to my;
Credit Card Information (Name as appears on card):*

First NameLast Name
Postal Code*
DAYS / HOURS OF OPERATION: Karate International San Antonio will follow the Northside Independent School District calendars and provide services on FULL days. Karate International San Antonio After School program will NOT operate on school holidays. Contact dojo for camp details.*
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DISCIPLINE POLICY: In an effort to provide your child and other students with a safe and fun experience, it is necessary that all students exhibit proper behavior, self-discipline and self-control. Correcting unsatisfactory behavior is time consuming and distracts from providing quality, safe, educational, and fun activities for the rest of the students. If we are unable to control a situation, we will contact the parents first by telephone at or near the disturbance, so that the parent may reinforce (by phone) the requirement that all students enrolled in the After School program behave satisfactory and follow instructions fully and promptly. Students that cannot by controlled by verbal commands or that are a constant disciplinary problem will be suspended from the program(s). Refunds will not be issues for students who are suspended due to behavior issues.*
Type initials above to consent
WAVIER & RELEASE: Buyer(s) understands that Student(s) is engaging in physical activity, along with the use of KISA’s facilities, equipment, training and instruction, which can be dangerous and could cause injury. Therefore Buyer(s) assumes all risk of injury to said Student(s). Buyer(s) / Student(s) hereby waives and releases any claim or right to sue KISA, its employees or agents for injury. Buyer(s) has carefully read this waiver & release and fully understands that it releases KISA of all liabilities for any injury that may occur. It is always advisable to consult your physician before undertaking a physical activity program, particularly those performed at KISA. Additionally, I hereby grant and authorize KISA the right to take, edit, copy, publish, distribute and make use of any and all photos or video taken of my child(ren) to be used in and/or for legally promotional materials and digital communications. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of and will not be returned.*
Type initials above to consent
LOSS/DAMAGE/THEFT: Karate International San Antonio (KISA) does not assume any responsibility for the loss, damage, or theft of any property belonging to the Buyer(s)/Student(s) and I agree by initialing above that Karate International San Antonio and its personnel are not responsible or liable for any such property in the event of loss, damage, or theft on or about the facility.*
Type initials above to consent
TRANSPORTATION RELEASE: I (parent or guardian) give my consent to Karate International San Antonio, its officers, agents, employees, individuals associated with the organization to transport my child(ren) named above to and from the authorized activities and events.*
Type initials above to consent
*Trade In Stock: I UNDERSTAND THAT KARATE INTERNATIONAL SAN ANTONIO IS A MARTIAL ARTS SCHOOL AND NOT A DAYCARE IN AS SUCH, THEIR STOCK-IN-TRADE IS NOT SUPERVISION AND CARE. THE SUPERVISION AND CARE OF MY CHILD(REN) IS INCIDENTAL TO THEIR PARTICIPATING IN THE PROGRAM AND THAT KARATE INTERNATIONAL SAN ANTONIO IS NOT ASSUMING RESPONSIBILITY OR THE PROVISION OF DAILY CHILD CARE OUTSIDE OF THE PROGRAM. THE INTENT OF KARATE INTERNATIONAL SAN ANTONIO IS TO TEACH PHYSICAL FITNESS/MARTIAL ARTS AND PHILOSOPHICAL CHARACTER BUILDING SKILLS.*
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EXTRA CHARGES: I acknowledge that afternoon martial arts classes, camps, parent's night out, tournaments and seminars are not included in monthly after school fees. *
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CANCELLATIONS, REFUNDS & ABSENCES: We understand that needs change and that some of these changes are unexpected. As a result, Karate International San Antonio will gladly issue a refund (minus the required $150 registration fee) for any cancellation request received in writing more than 14 days before the scheduled session date. No refunds, credits, or transfers are available for sick days or absences for any reason. (Please note that once your days are picked, we are unable to switch unless we have an opening and 14 day notice is given prior to the desired switch).*
Type initials above to consent
TECHNOLOGY POLICY: Unfortunately, the proliferation of wireless technology has made it increasingly difficult for Karate International San Antonio staff to define a consistent policy that keeps appropriate content in front of all after schoolers. As a result, children are NOT allowed to share or allow others to use their electronic devices. After Schoolers will be permitted to use their own electronic device for recreational fun from 5:00pm-6:00pm ONLY. Karate International San Antonio staff will not be reliable for setting restrictions or filters on after schooler's personal devices.*
Type initials above to consent
Sign Document*
Date Signed*

MonthDayYear
Special notes and/or instructions for staff:

Parent Transportation Responsibility Checklist
I, parent or legal guardian, authorize my child to be picked up by an Karate International San Antonio designated vehicle and I understand that it is my responsibility to do the following:
1. Notify my child's school teacher(s) that he/she will be riding with Karate International San Antonio van and the days they will be picked up by Karate International San Antonio.*
Type initials above to consent
2. Notify my school's office, confirming my child should be in line for the Karate International San Antonio van, and that Karate International San Antonio is listed as an authorized pick up for early release or inclement weather for my child.*
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3. Call Karate International San Antonio at (210)585-3433, or notify Karate International staff by email at ariana.reyes1991@gmail.com, BY NOON, if my child will not by picked-up on a given day.*
Type initials above to consent
4. Responsibility for your child boarding the Karate International San Antonio vehicle lies solely with the school and/or teacher. Our responsibility begins when your child boards the designated vehicle.*
Type initials above to consent
Sign Document*
Should be Empty:

Karate International After School Program

Karate International San Antonio Martial offers transported after school care children ages 5-13. NOW SERVICING: Mireles and Hoffmann Elementary Schools Briscoe Middle School!

Student & School Information

Select Date for After School Services to Begin:

Parent Information

Emergency Contacts/Authorized Pickup

Medical / Health Information

Medication

Medical Release & Transportation Consent

Classes, Snacks, Payment, Policies & Procedures

Parent Transportation Responsibility Checklist