Tae Kwon Do Registration

Tae Kwon Do @ Monument Bible Church

Registration - Classes held Saturdays at 10:00 a.m. - Join anytime!
Participant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Parent/Guardian Name (if participant is a minor):

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Okay to text?*

YesNo
Email
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
In signing this form, I, the participant (OR parent or legal guardian of the participant), agree not to hold Monument Bible Church, its officers, employees instructors, or other agents, liable for any injuries, loss, damage or accident that may occur in particpating in this activity, sport. This is a physically demanding sport and injuries may occur.
MEDICAL TREATMENT PERMISSION: I authorize any leader of Tae Kwon Do at Monument Bible to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

I have read and agree to the terms and conditions stated above.
Please sign below (if minor, parent or guardian must sign below):*

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Tae Kwon Do @ Monument Bible Church