Online Registration Form

Student Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

Age*

Mobile Number*

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

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Regulations

The STUDENT warrants, represent, and acknowledges, that American Korean Taekwondo LLC, has fully informed him/her of the nature and risks involved in the sporting and athletic activates taught by AKT; that he/she is physically and mentally fit to participate in such activities; that he/she will not use the knowledge and skills acquired from AKT IN ANY WAY BUT A DISCREET AND JUDICIOUS AMNNER: that he/she will abide by the RULES AND REGULATIONS of American Korean Taekwondo LLC.; that he/she assumes the risk of any and all ACCIDENTS and INJURIES of any kind sustained by him/her by reason of or in connection with said activities, and hereby RELEASES DISCHARGES AND ABSOLVES American Korean Taekwondo LLC, its agents, programs and employees for and from any and ALL LIABILITY or RESPONSIBILITY for Such ACCIDENT or INJURIES, whether the same are caused by or attributable to their negligence of any of them. I also authorize that American Korean Taekwondo LLC has the right to use all photographs or video taken of me or my child while participation in the American Korean Taekwondo LLC programs for advertising and promotional material.

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Signature*

American Korean Taekwondo Trial Lesson Appointment

1560 Teaneck Rd. Teaneck, NJ 07666