Hogan’s Victory Karate Registration Form

Athlete Information

Athlete's Name

First NameLast Name

Birth date

DayMonthYear

Gender

Date

Parent/Guardian Information (if athlete is under 18)

Name

First NameLast Name

Mobile Number

eg 021Phone Number

E-mail

example@example.com

Alternative Emergency Contact

Emergency Contact's Name

First NameLast Name

Mobile Number

eg 021Phone Number

Does the athlete have asthma, allergies, or any other medical condition? If yes, please describe.

Membership

Monthly dues are still required to be made every month to keep your child’s spot. If payment is not made then your child’s spot will be replaced.

Please understand that if you drop from class and want to re-register a registration fee will be applied. The registration fee is posted at the time of starting classes and each January. That covers your child from January to January, only if you continue classes consistently through the year. If you choose to not attend summer classes or drop a school year class you will be required to re-register and will have to pay the $50.00 per student registration fee to re-enroll in classes and will be placed on the waiting list till a spot is available for your child.

Hogan's Victory Kickboxing & Karate reserves the right to remove any student(s) from class(es) if you have not been in attendance or non-payment, however the account holder is still responsible for all amounts due on account.

Monthly dues are due every 1st of the month. If monthly payment is not made by the 7th of each month a $20 late fee is automatically added.

Payment option

Acknowledgement

I understand that all sports carry a risk of injury and that Hogan's Victory Kickboxing & Karate is not responsible for injuries or loss suffered as the result of participating in these activities.

From time to time Hogan's Victory Kickboxing & Karate will post photographs of our athletes, coaches, and supporters online. I will let Sensei Michael Hogan-Herrera know by email if I do not consent to my or my child’s photos being shared.

Hogan's Victory Kickboxing & Karate will give 30 days written notice of any fee increase.

Medical Authorization

In the event of an injury or medical emergency, I allow Hogan's Victory Kickboxing & Karate to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above.

I understand that all reasonable efforts will be made to contact the athlete’s parent and/or emergency contact if an injury or medical emergency occurs.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature