Membership





DeJohnette Martial Arts Academy Student Enrollment Form



DeJohnette Martial Arts Academy
Student Enrollment Form

This form must be completed by an adult, 18 years of age or older. Before submitting this form you must read and agree to abide by the terms and conditions of the Studio Agreement and Release Form. (Click here) for a printable copy of the Enrollment and Release Form.
Name: (required)
Address:
City: Zipcode:
Home Phone:(required) Cell Phone:
Email: (required)

STUDENT INFORMATION
Name: (required)
Age: (required) Date of Birth: (required)

2nd & 3rd STUDENT INFORMATION
Name:
Age: Date of Birth:
Name:
Age: Date of Birth:

Comments: (required)-
    List any medical reasons that may restrict the student(s) from participating in Soo Bahk Do/Karate. If there are none, indicate “No Medical Restrictions.” Please include your Emergency Contact information.


APPROVAL OF PARENT/LEGAL GUARDIAN ON BEHALF OF MINOR

I AM THE PARENT AND/OR LEGAL GUARDIAN OF THE ABOVE STUDENT(s) (minor). I HAVE READ AND UNDERSTAND THE STUDIO AGREEMENT AND RELEASE OF LIABILITY AND HEREBY AGREE TO BE BOUND BY EACH OF ITS TERMS AND CONDITIONS. BY SUBMITTING THIS FORM, I HEREBY GRANT MY EXPRESS PERMISSION FOR THE ABOVE-NAMED MINOR TO ENGAGE IN THE PRESCRIBED COURSE OF INSTRUCTION.