Karate So Registration Form

Student Information

Student Name

First NameLast Name

Gender

Other

Birth date

DayMonthYear

Select class

Previous Martial Arts Experience

If you choosed YES, please describe your experience

Current level

Other

Parent/Guardian Information (if student is under 18)

Name

First NameLast Name

Describe your relationship to student

Mobile Number

Format: (000) 000-0000.

E-mail

example@example.com

Alternative Emergency Contact

Emergency Contact's Name

First NameLast Name

Relationship to student

Mobile Number

Format: (000) 000-0000.

Does the student have any medical conditions, allergies, injuries, medications, physical limitations or other health information that the instructors should be aware of?

Medical Authorization

In the event of an injury or medical emergency, I allow KarateSo to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above.

I understand that all reasonable efforts will be made to contact the student'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

Please verify that you are human

Registrartion Form