Maine Traditional Karate: Registration
Student Full Name *
Student Birth Date *
MM
/
DD
/
YYYY
Student Class Group *
Select the best class group based on age
Email Address *
Phone Number *
Mailing Address *
Please write out as follows: Mailing Address, City, State, Zip
Sign Up For Location *
Required
Emergency Contact Name *
Emergency Contact Phone Number *
Medical Conditions
If there are any medical conditions that may impact your ability to participate in a physically active impact sport, please note them here. This is to help inform instructors in order to keep the student safe.
Additional Comments/Information
Register additional students? *
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