LDFA Kids (Ages 7-13) Registration Form

Kids Martial Arts Program (Ages 7-13)

Registration Form
Welcome to the Lethwei Dan Fight Academy at A Foot Above Fitness!

LDFA KIDS (7-13 yrs)
REGISTRATION IS OPEN

Join our class today!
Program Info & Class Schedule
Our Kids Martial Arts Program for ages 7–13 combines a high-energy blend of Muay Thai and No-Gi Brazilian Jiu-Jitsu, helping kids build confidence, discipline, coordination, and strength while having fun.

Students will develop real skills, improve focus, and learn respect, all within a positive, structured, and team-oriented environment.

Classes are led by Lethwei Dan—one of Orléans’ most experienced and energetic instructors, Pro Fighter, and World Champion—who is passionate about helping each child grow both on and off the mats.

Class Schedule

Tuesday 5:00-6:00 pm
Thursday 5:00-6:00 pm
Saturday 10:00-11:00 am

Location: A Foot Above Fitness (110 Place d'Orleans Drive)

Price: $65.50 + tax / Bi-Weekly

For more info / questions, email us at lethweidanfightacademy@gmail.com or feel free to stop by the gym and chat with Coach Lethwei Dan!
Participant & Guardian Information
Please complete this form to register your child for our Kids Martial Arts Program (Ages 7-13). This form must be filled out by a parent or legal guardian. Payment details and waiver are included below. No payment will be processed until your child's first class. This will secure your child's spot in the program.
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Age
Parent/ Guardian Full Name

First NameLast Name
Relationship to Child
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Emergency Contact & Medical Info

*Contact used if Parent/ Guardian stated above cannot be reached
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to Child
Does your child have any medical conditions or major allergies we should be aware of?
If yes, please explain:

Membership Terms & Pre-Authorized Debit (PAD) Agreement
Membership Type

The Lethwei Dan Fight Academy: Kids Martial Arts Program (Ages 7-13) at A Foot Above Fitness:
- $65.50 + tax / Bi-Weekly
Membership Includes:
- All scheduled classes for The Lethwei Dan Fight Academy's Kids Martial Arts Program
- Access to The Combat Room & change rooms only. *All fitness equipment, weights & machines outside of The Combat Room are strictly off limits to children.
Payment Terms and Schedule:
- Total Amount: $65.50 + tax
- Payment Frequency: Bi-Weekly (every two weeks)
Non-Sufficient Funds Fee: A $30 fee will be charged for any bank withdrawl declined due to non-sufficient funds (NSF).

Cancellation Policy:
- Please inform The Lethwei Dan Fight Academy by e-mail of your cancellation request.
- We ask that you give us a 30-day heads-up if you need to cancel. We understand special circumstances may arise and we will do our best to accommodate you.
Personal Banking Information (PAD Authorization)
This secures your child’s spot in the program. No payment is processed until their first class — you’ll receive a confirmation beforehand.
Account Holder Name

First NameLast Name
Transit no.
Branch / Institution no.
Account no.
I authorize The Lethwei Dan Fight Academy to debit my bank account as outlined in the payment terms above. Pre-authorized debits will be processed by third-party processor, Rotessa. I agree to waive any legislative or regulatory requirement for pre-notification. I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. This authority is to remain in effect until the above business has received notification from myself of its change or termination. This notification must be received at least 5 business days before the next debit is scheduled.
Date

MonthDayYear
Date
Liability Waiver and Consent
I, first & last name* , am the parent or legal guardian of the child named above. I give permission for my child to participate in the Kids Martial Arts Program offered by The Lethwei Dan Fight Academy at A Foot Above Fitness. I understand that participation involves physical activity and the potential for injury.
I acknowledge and accept all risks and agree to release The Lethwei Dan Fight Academy and A Foot Above Fitness, its instructors, and affiliates from any and all liability for injuries or damages arising from participation in this program.
I certify that my child is physically able to participate in martial arts training and that I will inform staff of any health concerns.
I understand that this program takes place inside a larger gym facility that includes areas and equipment not intended for children. I acknowledge that the combat room is the only area where children are permitted during class, and that all other areas of the gym (including the weightlifting area and equipment) are strictly off-limits to children.
I agree to ensure that my child follows these safety boundaries at all times and understand that The Lethwei Dan Fight Academy and A Foot Above Fitness and its staff are not responsible for any injury that may occur if my child enters a restricted area of the facility.
I have read and agree to the terms above
Photo & Video Permission

From time to time, we may take photos or short videos during kids classes to share on social media and in our marketing.

By checking below, I give permission for Lethwei Dan Fight Academy and A FootAbove Fitness to include my child in these photos or videos.
By signing here you agree to all of the above terms and are confirming your child's registration for The Lethwei Dan Fight Academy Kids Martial Arts Program
Date

MonthDayYear
Date
Should be Empty:

Kids Martial Arts Program (Ages 7-13)

Program Info & Class Schedule

Participant & Guardian Information

Emergency Contact & Medical Info

Membership Terms & Pre-Authorized Debit (PAD) Agreement

Personal Banking Information (PAD Authorization)

Liability Waiver and Consent