After-School 2023-24 Registration

Aim and Focus After-School 2023-24
We are accepting new students at this time !!!!!
The program is currently full. We are accepting "waiting list" applications.*

Acknowledge this application will be placed on the waiting list
Student Information
Student Name*

First NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Birthdate*

MonthDayYear
Gender*

FemaleMale
Student Grade*

Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Student's School*

Live OakPond SpringsLaurel MountainSommerEnglandOther
Drop off School Name
Drop off School Phone

Area CodePhone Number
Drop off School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Helpful email addresses
The following emails addresses can be used to communicate with the appropriate staff in the program:
- office@aimandfocus.com : address for the Office Manager; general questions about the program; questions about when classes / activities are offered; "general" email account for the school
- billing@aimandfocus.com : specific questions about billing issues, statements received, charges posted to the account
- benjohnson@aimandfocus.com : question about training specifically for Master Johnson
Parent/Guardian Information
Parent/Guardian*

First NameLast Name
Primary Phone*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
E-mail*
Enrollment Authority

I have legal authority to enroll this student in the Aim and Focus Karate After-School Program. I accept responsibility for this enrollment.
Enrollment Authority*

Approved
Secondary Parent/Guardian Information

Secondary Information is not required
Secondary Parent/Guardian

First NameLast Name
Secondary E-mail
Secondary Primary Phone

Area CodePhone Number
Secondary Alternate Phone

Area CodePhone Number
Emergency Contact / Pickup Information
At least one Emergency Contact person (NOT a parent or guardian already listed) must be entered. This will be used if we can NOT reach the parent(s) / guardian(s) listed above.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship*
Additional Names & Numbers may be provided in the box
The following individuals are authorized to pickup the student (optional)
Authorized Pickup

First NameLast Name
Authorized Pickup

First NameLast Name
Additional Names may be listed in the box
Transportation
Authorization for Transportation

I authorize Aim and Focus Karate to transport my student(s) from school to the Aim and Focus Karate location. I also approve tranportations on school sponsored field trips.
Transportation*

Approved
Medical Information
Authorization for Emergency Medical Treatment

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the staff of Aim and Focus Karate to seek emergency medical treatment. This includes but is not limited to calling 911.
Medical Treatment*

Approved
Please list any special medical conditions, previous serious injuries or regular medications (type NONE if applicable)*
None
Doctor or Urgent Treatment Center Information
In the event of a medical emergency when parents / guardians can not be reached, we must have access to medical history for the student in order to provide access to this information for EMS.
Doctor or Emergency Facility Name*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Immunizations & Vision and Hearing Screenings
The student's immunization record is on file at the public/private school the student attends. All immunizations are current. All necessary Vision and Hearing Screenings as required by the Special Senses and Communication Disorders Act are current and on file at the students school.

At this time, Aim and Focus Karate does not require staff members to have specific immunizations or vacinations.
Immunizations & Vision and Hearing Screenings*

Validated
Fees
Registration Fee

There is a $50 non-refundable Registration Fee required before your enrollment will be accepted. There are also fees associated with the martial arts trainings (test fees, sparring gear, national association membership, etc.). These fees only apply when you approve of the purchase / clinic / belt test / etc.

Please indicate your payment preference below.

Monthly Tuition

Current Students: $300/month

New Students: $340/month

Sibling enrolling (discount of $35 / month)

Tang Soo Do Mi Guk Kwan annual membership fee:

All students must join this national martial arts organization. The annual membership rates are: $30 First family member, $20 Additional family members, $40 Black Belt Memberships

NOTE: Aim and Focus Karate pays the annual fee on behalf of our students.
Acknowledgement of fee structure*

Validated
Waiver & Financial Obligations
Liability Waiver

I am giving permission for the student listed on this form to participate in the 2023-24 Aim and Focus Karate After-School Program. I realize the staff and instructors will do everything in their power to protect my child when in their care. I will not hold them responsible and waive all claims against the Aim and Focus Karate School Inc. for any accidents that may occur when the student is in their care. I also acknowledge that Aim and Focus Karate Inc. does not provide medical insurance coverage for accidents.
Liability Waiver*

Approved
After-School Operational Policies Document
I have read and acknowledge the content of the "Aim and Focus Karate After-School 2023-24 Operational Policy Document". This document is available on the Aim and Focus Karate web site (www.aimandfocus.com). This includes review of our "Discipline and Guidance Policy" as well as the "Gang Free Zones" section.

Parents: Please take a moment to read the "After-School Operational Policies" it will answer many of your questions about our program and how we operate on a daily basis.
Operational Policy Document*

Approved
Financial Obligations
I agree to all financial obligations related to my student's attendance in the 2023-24 Aim and Focus After-School Program. These obligations are defined in the 2023-24 Aim and Focus After-School Program Operational Policies Document (available on the Aim and Focus Karate web site). I have reviewed this document and agree to the obligations.

Forms are available at the Front Desk to provide Credit Card and ACH Transfer information.
Financial Obligations*

Approved
Payment Options*

Credit CardACH / EFT Bank TransferCheck / Cash
Final Step !!!!
Final Enrollment Step

To complete your enrollment, you must physically sign (ink) the "Approved" enrollment form. Your enrollment form will be printed at the karate school and you will be asked to sign it only once.
Should be Empty:

Aim and Focus After-School 2023-24

We are accepting new students at this time !!!!!

Student Information

Helpful email addresses

Parent/Guardian Information

Secondary Parent/Guardian Information

Emergency Contact / Pickup Information

Transportation

Medical Information

Doctor or Urgent Treatment Center Information

Immunizations & Vision and Hearing Screenings

Fees

Waiver & Financial Obligations

After-School Operational Policies Document

Financial Obligations

Final Step !!!!