Shorin-Ryu Karate Club Application
Last name *
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First name *
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Middle Initial
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Birthdate *
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Weight
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Address *
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City *
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State *
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Zip code *
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Telephone number
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Email
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Do you have any medical problems that may interfere with Karate training?
ex. Athsma, joint injuries, etc
If yes please explain
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Have you studied any martial arts before?
If yes, what style & rank obtained
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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 *
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electronic signature of parent (if under 18)
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Date of application
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