Website New Customer Registration Form

Weclome to USA Karate! We are very excited for your family to try our Karate Program as well as learn more about our Character Development Program!

The first step is to schedule an Introductory Karate Class. At the Introductory class you will get to see the school, meet the instructors, take a sample class to get familiar with the class structure, and redeem your voucher!

Introductory Classes are offered weekly at the days / times below. Just fill out the information below and one of our staff members will reach out with more details!

Thanks!

David & Steven

Owners

Which location, day & time are best for the Introductory Class (select one for the entire family, ages 5+)?*

New Member Name*

First NameLast Name

New Member Sex*

MaleFemale

New Member Birthday*

MonthDayYear

Parent/Guardian Full Name if Junior member

First NameLast Name

Cellular Phone Number*

E-mail*

How did you learn about USA Karate?

FacebookGoogle or Internet SearchAt an Expo eventMailbox Print Ad in a paper

The art of karate is physical and the practice of such art can result in injury toStudent. Accordingly, the student shall participate at his/her own risk and it is expressly agreed that USA Karate, DYSSMA, LLC or DBYMA, LLC shall not be liable for any claims, injuries, damages, or actions whatsoever to student orstudent’s property or person arising out of the practice of Karate or connectedwith the use of any of the services and facilities of the School and studentdoes hereby expressly release and discharge USA Karate, DYSSMA, LLC and DBYMA,LLC from all such claims, injuries, damages or causes of action and from allacts of active or passive negligence on the part of the School, its servants,agents, employees and students.*

I Agree as Member or as Parent/Guardian