Ninja Registration Form

Ninja Registration Form
Ninja Name*

First NameLast Name
Ninja Birth Date*

MonthDayYear
Previous Ninja Experience, if any*
Parent Contact Name (if ninja is under the age of 18)

First NameLast Name
Parent / Ninja Contact Phone*
Parent / Ninja Contact E-mail*
example@example.com
Class Selection*

Lite Warrior Pass (1 Class / Week)Double Action Ninja Pass (2 Classes / Week)
Please list any medical conditions, injuries, allergies, or special considerations we should be aware of:
Please let us know if your child requires any special assistance or if there is anything we should know to support them best:
Deposit & Scholarship Raffle Acknowledgement

To complete pre-registration, a $100 deposit/downpayment is required.This deposit secures your ninja’s spot for the upcoming term. All registered ninjas are automatically entered into the scholarship raffle.The deposit will only be refunded to scholarship winners. After the raffle is drawn, full registration opens, and remaining balances must be paid on or before January 6th, 2026.
Deposit & Scholarship Raffle Acknowledgement*

I acknowledge and agree to the deposit and payment terms above.
Facility Entry Acknowledgement*

I understand that all parents, guardians, and athletes are required to follow all gym rules and regulations upon entry to the facility.
Please make payment to:

Name: Brook Miller

Bank: First Caribbean International Bank, Speightstown

Account Number: 1001099280

Transit Number: 9636

1st Pay 1-246-838-5946 (Proof of payment may be requested)
Final Confirmation*

I confirm that the information provided above is accurate and complete.
Should be Empty:

Ninja Registration Form

Deposit & Scholarship Raffle Acknowledgement