Verner Elementary - Falcon 1 Karate Membership Form
Office: 205-758-2242
Karate Lessons at Verner Elementary

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Mailing Address:
Team Lee Athletics LLC
PO Box 70323
Tuscaloosa, AL 35407
Parents Information
School *
First Name *
Last Name *
Contact Information
Present Mailing Address *
City *
State *
Zip Code *
Father Cell *
Mother Cell *
Does Cell Receive texts? *
Email Address *
Work Phone
1st Student Information
Enter the information below for your student. If registering more than two students please fill out multiple forms.
1st Student Name *
1st Student Date of Birth *
2nd Student Information
Enter the information below for your student. If registering more than two students please fill out multiple forms.
2nd Student Name
2nd Student Date of Birth
Please note, for the student to receive maximum physical and mental benefits from this program requires a commitment of time. It takes repetition of physical moves and positive mental attitudes for them to become automatic reflexes. By filling out the form below, you are giving permission for your child/children to participate in a Team Lee Athletics L.L.C. program for the school year. You also release Team Lee Athletics L.L.C and any/all of its representatives from any/all liability for any and all possible injuries/accidents/illness that may occur during the child/children's performance, training, or association with, and for, any of the Team Lee Athletics L.L.C. programs.
Special information about Student
Back up contact name
Back up contact phone
Lesson Plan weekly 45 minute lessons during the school year (August - May).

Class Tuition: $770 + $89 Registration fee = $859 if paid in full, or 10 installments of $77 post-dated checks August through May, or 10 installments of $79.31* by account bank draft or credit/debit card.
Registration Fee $89
Annual Membership fee $30 Free Falcon 1 Athletic Tshirt!
Uniform $60 Value
Patches $15 Value

+ 1st Installment of $77


* All fees are non-refundable.
Billing Consent *
20% Tuition Discount for 2nd Child
*3% finance/draft fee applies for payments made in installments. 3% convenience fee applies for payments accepted via Paypal
If Paying by Checking Account Draft (Preferred)
Please provide checking account information below if paying by checking account draft
Billing Account Information
(Make checks out to FALCON 1 DEFENSE)
Name as shown on account
Checking Account
Routing Number
Account Number
If Paying by Credit Card
Please provide credit card information below if paying by credit card instead of checking draft.
Credit Card Information
Credit Card Number
Expiration Date
Zip Code
Acknowledgement of Payment Required to Complete Registration *
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