Martial Arts Course Registration Form

Tomball Soo Bahk Do Registration
Member Information
Member's Name*

First NameLast Name
Birth date

MonthDayYear
Gender

MaleFemale
Today’s Date*

MonthDayYear
Date
Parent/Guardian Information (if athlete is under 18)
Name

First NameLast Name
Mobile Number*
E-mail*
example@example.com
Alternative Emergency Contact
Emergency Contact's Name*

First NameLast Name
Mobile Number*
Does the member have asthma, allergies, or any other medical condition? If yes, please describe.
Membership:

Initial sign up is $300/member and covers the first month of tuition, uniform, and first test fee.
Number of Members Interested*

1 Member at $155/month2 Members at $290/month3 Members at $405/month4 Members at $500/month5+ Members
Acknowledgement I understand that Martial Arts carry a risk of injury and that Tomball Soo Bahk Do,LLC is not responsible for injuries or loss suffered as the result of participating in these activities. From time to time Tomball Doo Bahk Do, LLC will post photographs of our members, instructors, and supporters online. I will let Tomball Soo Bahk Do, LLC know by email if I do not consent to my or my child’s photos being shared. Tomball Soo Bahk Do, LLC will give 30 days written notice of any fee increase.
Medical Authorization In the event of an injury or medical emergency, I allow Tomball Soo Bahk Do,LLC to provide first aid, arrange transport to a medical facility, and authorize emergency treatment as recommended by a doctor for the member named above. I understand that all reasonable efforts will be made to contact the member'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*
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Tomball Soo Bahk Do Registration