New Student Registrations
Student First Name *
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Student Middle Name
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Student Last Name *
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Date of Birth Month *
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Date of Birth Year *
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Mailing Address - House # and Street Name *
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Mailing Address - Apartment / Suite #
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Mailing Address - City, State, Zipcode *
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Home Phone Number
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Cell Phone Number
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Other Phone Number
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e-mail address - To be used only for Monthly Newsletter / Class Announcements
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Spouse / Parent / Guardian - Name
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Spouse / Parent / Guardian - Phone Number
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Spouse / Parent / Guardian - Other Number
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Emergency Contact - Name
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Emergency Contact - Phone Number
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Any Handicaps, or medical issue that would affect training? *
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Currently taking medication for blood pressure? *
Any history of heart disease? *
Any history of breathing trouble or lung disorder? *
If any are yes - Family Doctor's Name
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Family Doctor's - Phone Number
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PLEASE READ CAREFULLY. THIS IS A LEGAL AGREEMENT
I understand that under the terms of this agreement the school obliges itself to furnish me with a competent instructor and facilities for teaching the lessons. The length of time allocated for the lessons are usually two lessons per week. Failure to take all lessons contracted for shall not relieve me of my obligation to pay the total tuition agree upon. I further understand if I am absent or withdrawal there will be no refunds for any tuition paid. Lessons are not conducted on national holidays or on days of Association sponsored tournaments.

In consideration of being accepted as a member, I the undersigned, agree to abide by the constitution and by-laws of this organization and all applicable rules and regulations of The Thief River Falls Tae Kwon Do School, and its affiliations; The United States Chang Moo Kwan Tae Kwon Do Union.
Do you understand and agree to the preceding agreement? *
PLEASE READ CAREFULLY. THIS IS A LEGAL AGREEMENT.
AGREEMENT, RELEASE OF LIABILITY AND
ACKNOWLEDGMENT OF ASSUMPTION OF RISK

I fully understand that Tae Kwon Do and Kumdo is a contact sport.

I, for myself and on behalf of my heirs, assigns, personal representative and next of kin, HEREBY RELEASE AND HOLD HARMLESS Michael C. Perish, The Thief River Falls Tae Kwon Do School, its officers, officials, agents, employees, volunteers, owners, and/or lessors of premises (“Releasees”) used to conduct Tae Kwon Do, Kumdo, Self Defense, martial arts, and/or physical fitness activities, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSE BY NEGLIGENCE OF THE RELEASEES OR OTHERWISE; except that which is the result of gross negligence and/or wanton misconduct.

I understand and agree that this Release of Liability Agreement covers each and every Tae Kwon Do, Martial Art, and/or physical fitness activity or event in which I participate hereafter.

I HAVE READ THIS AGREEMENT, RELASE OF LIABILITY AND ACKNOWLEDGEMENT OF ASSUMPTION OF RISK, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT
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Electronic Signature of Student, or Parent / Guardian if student is a minor *
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Today's Date *
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