Authorization form for Karate classes
Child name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Add photo
*
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Parents
Mother's name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Father's name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Does your child have any chronic illnesses? If yes, what are they?
Сonfirm that my child has no contraindications or limitations for practicing karate.
Сonfirm that the attending physician has permitted to engage in karate.
Authorize the processing and systematization of the provided personal data.
Authorize the taking of photos, or videos of the child for use on the club's website and social networks.
Authorizer name
*
First Name
Last Name
Email
*
example@example.com
Signature
*
Submit
Submit
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