Primm's Taekwon-Do Enrollment Form
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Student's Name:
Street Address
City
State
Zip Code
Parent Name(s)
Best Phone Number to Reach You
Alternate Phone Number(s)
Parent(s) Email Address
Parent(s) Employer
Sibling Names
*
Which Taekwon-Do program will student attend?
Student Birthdate
Does student have medical or mental health issues we should know about?
In order to meet the needs of your student, please check the box indicating the benefit(s) you hope your child will achieve from studying martial arts:
I hereby agree, by my initials below, that I am fully responsible for any risk of personal injury and agree to release Frank Primm, Primm's Taekwon-Do, and other related parties of any liability in case of injury in any way.
Date
MM
/
DD
/
YYYY
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