Shorin-Ryu Karate Club Application
Last name *
First name *
Middle Initial
Birthdate *
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Weight
Address *
City *
State *
Zip code *
Telephone number
Email
Do you have any medical problems that may interfere with Karate training?
ex. Athsma, joint injuries, etc
Clear selection
If yes please explain
Have you studied any martial arts before?
Clear selection
If yes, what style & rank obtained
I understand the possibility of injury which could occur in Karate as in any other contact sport or physical activity, an I will not hold any Instructor or person in this organization, or Wilmington Teen Center responsible for physical injury occurring to my self/son/daughter during training. I understand there is an optional donation fo $3.00-$5.00 per class or $20.00-$30.00 per month *
Electronic signature of applicant *
electronic signature of parent (if under 18)
Date of application
MM
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DD
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Submit
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