Karate Class Ongoing Every Wednesday
Fill out the form carefully and sign up of each participant.
Class Date
Beginners Class - October 1st, 8th, 15th, & 22nd at 5:30pm - 6:30pm
Class Date
Advance Class - October 1st, 8th, 15th, & 22nd - Yellow/Orange Belts at 6:30 - 7:30pm
Class Participant Name
*
First Name
Last Name
Gender
*
Male
Female
N/A
Age
*
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
City where you live
*
Number in Household
*
Number over 62
*
Family/Parent/Guardian Name
*
First Name
Last Name
E-mail
*
Mobile Number
*
-
Area Code
Phone Number
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October Monthly Family Donation
$
100.00
October Monthly Family Donation
October IRC Reimbursement
$
100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles
Already donated this month / Self Determination
$
Free
Please hit PayPal to check out. (Zelle - rocknourdisabilities@gmail.com)
Total
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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