Black Belt Center After School Program Logo
  • Black Belt Karate Center Afterschool Program

  • Safety First

    • We are licensed by DCF (#C09OR0033)
    • CPR/First Aid Certified
    • Certified by the Martial Arts Teachers' Association (MATA)
  • STUDENT INFORMATION

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  • Medical Information: I hereby grand permission for the staff of Black Belt Center to contact the following medical personnel to obtain emergency medical care if warranted.

  • Contacts: Child will be released only to the custodial parent or legal guardian & the persons listed below. The following people will also be contacted & are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason the parent or legal guardian cannot be reached.

  • STUDENT CONDUCT & DISCIPLINARY PRACTICES

  • All students are expected to follow the rules outlined in the student manual. Our rules are the same as the public school. Our practice is to use time out as a form of behavior modification. Parents will be notified if the student should have recurring behavior issues and appropriate action discussed and taken. If a student should become uncontrollable – parent will be notified for immediate pick up. If a student exhibits recurring behavior issues he/she may be placed on a restriction from specific activities and probation for a specific length of time – if issues are not resolved a student may be removed from the program. A student may be suspended from the program for a specific time period if the behavior is of a dangerous or outrageous manner. Student issues will be discussed with the parent on a daily basis if warranted.

    I give permission to the BLACK BELT KARATE CENTER to transport my child to attend the program at the BLACK BELT KARATE CENTER. I give authorization and permission for field trips. I authorize the program supervisor to arrange for transportation and treatment of my child and understand that I am financially responsible for any expenses incurred on behalf of my child in seeking medical attention and understand that trips are subject to change. I hereby agree to waive any and all claims for personal injury, damage or other loss that may arise out of my child’s activities at the BLACK BELT CENTER and further agree to hold harmless and indemnify the center, its principals, employees and agents for any such injuries or loss.

    I have also received a copy of the Black Belt Center’s Afterschool program pricing and policies sheet. In addition, I grant permission to the staff of this facility and DCF to have access to my child’s records.
    Section 402.3125(5), Florida Statutes requires that parents receive a copy of the child care facility brochure, “Know your Childcare Facility,”

    Section 65c-22.006(4) ©1, Florida Administrative Code, requires that parents are notified in writing of the disciplinary practices used by the child care facility.
    By signing below you verify that you have received/advised of the above items and that all information on this enrollment form is complete and accurate.

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