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Abington Martial Arts - Karate Registration
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Abington Martial Arts Academy
Student - First and Last Name *
Student Date of Birth *
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Home Address *
City, State, Zip *
E-Mail Address *
Parent or Guardian Cell Phone number *
Are there any physical or mental disabilities that the insructor should be aware of? *
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If you answered yes to the above question, please provide explanation of what the condition is.
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