Empower Martial Arts Academy
8776 Lantana Rd. Suite A-112 Lake Worth, Florida 33467 561-336-5554 / Empowermaa@gmail.com / Empowermaa.com
Welcome to Empower Martial Arts Academy!
Thank you for starting your journey with Empower Martial Arts Academy — where confidence, discipline, and respect are at the heart of everything we do.Whether you're joining us for camp, our after school program, or Taekwondo/Kickboxing classes, we're excited to support your growth every step of the way.
Account Email Address
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This will be the main email we use for your registration, including all communications, file access, and program updates. Please use a personal email you check regularly. If enrolling multiple students, this email will apply to the entire household account.
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Student Information
Please fill in the basic information about the student/s who will be enrolling in the program.
Enrollment Date
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Month
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Day
Year
Date
Student's Full Name
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First Name
Middle Name
Last Name
Suffix
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student's Date of Birth
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Month
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Day
Year
Date
Student's Age
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T-shirt Size
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Please Select
Adult - S
Adult - M
Adult - L
Adult - XL
Please note that t-shirt will may not be provided for Flip Squad enrollees.
Program Selection & Requirements
Please review and complete the questions below based on the program your child will be participating in. This helps us tailor their experience, ensure we meet any specific needs, and prepare for any program-specific guidelines or requirements. If you've selected more than one program, answer all questions that apply to your child’s enrollment.
Which program(s) would you like to enroll your child in?
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Taekwondo Program
Kickboxing Program
Women’s Only Program
Other
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Program Agreement, Waiver, Code of Conduct and Payment
This section outlines important information about payment, safety, media consent, behavior expectations, and your acknowledgment of program policies.
Before proceeding, please take a moment to carefully read the following agreement. It includes important information about program safety, conduct expectations, emergency procedures, and media consent.
I acknowledge and agree to the following payment policies for Empower Martial Arts Academy.
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Late fees will be automatically charged to the card on file.
Camp must be paid by the Friday of the week before the camp begins.
Special events must be paid at least one day prior to the event.
Failure to pay by the due dates will result in a $25 late fee per student, applied after a one-week grace period. An additional $25 late fee per week will be added for each week the payment remains unpaid.
If the balance becomes one month past due, all services-including school pickup—will be suspended until payment is made in full, and your account may be sent to collections.
All members paying by credit card, debit card, or ACH are required to enroll in automatic monthly billing (“AutoPay”). If AutoPay is not established at the time of enrollment, or if AutoPay is removed at any time, a $10.00 monthly administrative fee will be added to the account each month until AutoPay is properly set up and active. Accounts will continue to be billed this administrative fee until an AutoPay authorization is received and successfully processed.
By entering your full name and signature at the end of this section, you confirm your understanding and acceptance of these terms either as the student or on behalf of the enrolled student.
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I understand that participation in martial arts, after school programs, and camps may involve physical activity and inherent risks. I voluntarily accept full responsibility for any potential injuries or incidents that may occur during participation. I agree to release Empower Martial Arts Academy, LLC, its staff, instructors, and affiliates from any liability related to injury, loss, or damage arising from participation in any program or event, including field trips and physical activities.
In the event of an emergency, I grant permission for the academy to seek medical attention from licensed professionals, including transportation to a hospital or medical facility, should it be deemed necessary.
I also grant permission for Empower Martial Arts Academy to photograph or record my child (or myself) during classes and events. These materials may be used for promotional, educational, or informational purposes across print, digital, or social media platforms. I waive the right to review or approve final versions and understand no compensation will be provided for such use.
I understand that the program enforces a clear Code of Conduct, including a three-strike system for rule violations and a zero-tolerance policy for bullying. Disruptive, disrespectful, or inappropriate behavior — including physical aggression, verbal abuse, profanity, or bullying of any kind — may result in disciplinary action, including removal from the program. I agree to support these values and will encourage my child to act with integrity, kindness, and respect both in and out of class.
Students may be terminated from the program at any time without a refund. Additionally, if a participant chooses to withdraw, a two-week notice is required.
Monthly Membership & Camp Billing Policy
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Membership dues are billed at a fixed monthly rate. This rate does not increase or decrease based on the number of classes attended, the number of days in a given month, scheduled closures, or holidays.
Some months may include fewer calendar days, while others may include additional days or an extra week of classes. Additionally, the academy may be closed on certain holidays or for scheduled breaks. Regardless of these variations, the monthly tuition remains the same.
We do not provide prorated adjustments for shorter months, holiday closures, missed classes, or any other scheduling variations, nor do we charge additional fees for longer months.
All camp programs—including but not limited to Summer Camp, Spring Camp, Thanksgiving Camp, Winter Break Camp, and other special programs—are also non-prorated. No refunds, credits, or reductions will be given for partial attendance, missed days, or schedule conflicts.
New enrollments may be prorated for the initial partial month only. After the first billing cycle, all tuition will be charged at the full monthly rate.
By enrolling, you acknowledge and agree that all tuition and camp fees are fixed and non-prorated, regardless of attendance, calendar variations, or closures.
I have read and understood the Program Agreement, Waiver, and Code of Conduct provided. By entering my full name, I acknowledge and agree to all terms stated, and understand that this serves as my digital agreement.
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Participant’s full name (if over 18) or parent/guardian’s full name (if under 18)
Signature
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🎯 Goal & Growth Reflection (Optional but encouraged, please click NEXT to skip this part)
We encourage you to complete this section to help us better understand your needs, motivations, and personal development goals. This isn't mandatory, but it helps us support you more effectively throughout your journey with us.
What are your main goals for enrolling the student/s in our martial arts program?
Build self-confidence and self-esteem
Improve focus and discipline
Develop physical fitness and coordination
Learn effective self-defense skills
Instill values like respect and integrity
Support emotional regulation and self-control
Other
Rank the following areas based on what matters most (drag and drop the categories below to rank them in order of importance, from top to bottom).
What is one thing you hope to gain or improve in the first 3 months?
Is there anything you’d like us to know about your learning style, personality, or needs?
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Spreading the Word
We’d love to know how you found out about us! Please select the option that best describes where you first heard about Empower.
How did you hear about Empower?
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School
Event
Family or Relative
Friends
Word of Mouth
From a Current Employee
Other
Type the school/event here
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