New Phase Karate Registration Form

New Phase Karate Academy

Contact Us: Phone: 916-667-6267 Email: newphasekarate@gmail.com
Address:

Swanston Community Center: 2350 Northrop Ave Sacramento, CA 95825 US
Shotokan Class Schedule

This class is taught by Sensei Luis Adrian Perales and supervised by Sensei Luis Alberto Perales, chief instructor of NP Shotokan & 4th Dan SKIF.

TUESDAYS & THURSDAYS

COMBINATION CLASS (GENERAL ALL LEVELS):

6:00PM TO 7:00PM

ADVANCED CLASS:

6:00 PM to 7:45 PM
Registration Form

Please fill out form below.
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date

Additional Family members
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date

Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
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Phone Number
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Emergency Contact: Name

First NameLast Name
Emergency Contact: Phone Number
Please enter a valid phone number.
Release of Liability

Please review and by signing below, you acknowledge the following.
I, the parent/guardian/participant, herby agree to allow the individual (s) named herein to participate in the aforementioned activity(ies), and I further agree to indemnify and hold harmless New Phase Karate Academy, all of its officers, employees or officials harmless from and against any and all liability for any accident or injury or any claim of damages which may be suffered by the aforementioned individual(s) arising out of or in any way connected with his/her participating in this activity without regard to the active negligence of New Phase Karate Academy or its officers, agents, employees or officials. Participant expressly waives any and all claims for damages or liabilities that arise from the use of the property or participating in a New Phase Karate Academy Activity and hereby expressly waives any claim or right to damages to property personal injury or damages occasioned by the loss use of the property or cancellation of the New Phase Karate Academy sponsored activity when the loss or cancellation is due to an interruption in power to the property. I give New Phase Karate Academy permission to use photographs of my child/myself taken during this event to be used for publicity purposes on the means of publicity. I understand that my child/ I may or may not be identified by name when photos are used for publicity purposes.

30 DAY NOTICE OF CANCELLATION OF AUTOMATIC PAYMENT. I will give New Phase Karate Academy a 30 day notice if I need to modify or cancel my automatic payment. If I fail to do so, I will be responsible for the following months membership payment.
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My Products*

New Phase Shotokan KarateThis monthly membership includes UP TO 2 classes per week. This membership DOES NOT include competition team class. Must give 30 day notice before cancelling. NO REFUNDS.

$65.00 for each month

NP Family Plan (2 Family Members Max) Product Image

NP Family Plan (2 Family Members Max)This monthly membership includes UP TO 2 classes per week. This membership DOES NOT include competition team class. Must give 30 day notice before cancelling. NO REFUNDS.

$125.00 for each month

NP Family Plan (3 Family Members Max) Product Image

NP Family Plan (3 Family Members Max)This monthly membership is for a family of 3 max. It includes UP TO 2 classes per week. This membership DOES NOT include competition team class. Must give 30 day notice before cancelling. NO REFUNDS.

$180.00 for each month

Total

$0.00

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New Phase Karate Academy

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Release of Liability

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