Dar-ul-Islah Taekwondo Registration
Dar-ul-Islah boys, girls and adults Taekwondo Program registration. Program runs Sat & Sun from 1:30 pm - 3:00 pm ages 5 years and up.
Primary Member Information
The primary member responsible for students and fees
Member (Parent) - Name *
Member - Address *
Member - Phone *
Member - Email *
Member - Relation *
Students Information
Student 1 - Name *
$50 Monthly Fees
Student 1 - Birth Date *
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Student 1 - Gender *
Student 1 - Email
Student 2 - Name
$40 Monthly Fees
Student 2 - Birth Date
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/
DD
/
YYYY
Student 2 - Gender
Clear selection
Student 2 - Email
Student 3 - Name
$30 Monthly Fees
Student 3 - Birth Date
MM
/
DD
/
YYYY
Student 3 - Gender
Clear selection
Student 3 - Email
Student 4 - Name
$20 Monthly Fees
Student 4 - Birth Date
MM
/
DD
/
YYYY
Student 4 - Gender
Clear selection
Student 4 - Email
Student 5 - Name
$20 Monthly Fees
Student 5 - Birth Date
MM
/
DD
/
YYYY
Student 5 - Gender
Clear selection
Student 5 - Email
Emergency Information
List emergency contact information in case we can't reach the primary member
Contact 1 - Name *
Contact 1 - Relation *
Contact 1 - Phone *
Contact 1 - Email
Contact 2 - Name
Contact 2 - Relation
Clear selection
Contact 2 - Phone
Contact 2 - Email
Emergency Release Statement
I the primary member is representing myself or I am the parent or legal guardian of all the students registered and hereby assume full responsibility for the program fees and all the risks of participation in activities associated with this contact Martial Arts class. I do hereby authorize the staff of Dar-ul-Islah to obtain medical aid for registered students from a paramedic unit, ambulance or hospital in case of emergency. *
Required
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