Yee's Southern Lions Student Enrollment Form

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www.yeessouthernlions.com

Email *

Student's Full Name *

Gender *

Date of Birth *

YYYY

If under 18, please provide the name of parent or legal guardian:

Address *

City *

State *

Massachusetts

Other:

Zip Code *

Phone Number (please note we will send text notifications to this number) *

Secondary Phone Number (please note we will send text notifications to this number)

Email *

Secondary Email

In case of emergency, please list the name to notify *

Phone number of listed emergency contact *

Injuries and Allergies

Please list any past or present injuries or medical conditions that may affect your training:

Please list any allergies you have and/or medications that you are taking that we should know about:

Past Experience

Tell us about any past experience that you have with martial arts or lion dance

Mini Survey

How did you learn about us?

What would you like to get out of your experience at the school?

Terms of Agreement

I understand that the martial arts program(s) taught at Yee's Southern Lions involves physical training, activities and physical contact with other individuals, which can result in serious physical injury to the participants. I hereby release Yee's Southern Lions, its instructors and all those affiliated with them, from all responsibilities of any injury. I accept full responsibility for such injuries. Participation in the program and any school related activity or event is at my own risk. I also understand that I may be taught by any of the school instructors and by Sifu Christopher Yee. Furthermore, I understand that my membership with the school may be suspended or revoked at any time, without prior warning with or without an explanation of such suspension or revocation. I also hereby consent to and authorize the use of photographs, films, slides, and videotapes of my children and/or I participating in activities for use in public media, advertising, and publicity purposes.

By Selecting the Option Below, I agree to have read and understand the above terms of agreement.

I have read and understand the above terms of agreement.

Monthly Fee Agreement

Monthly Fee $80 due on the 1st of each month/the first practice of each month + One Time Registration Fee of $80 (this includes your uniform)

If you are a Yee Association Member then your monthly fee, is waived. Registration Fee still applies.

By Selecting the Option Below, I am fully aware of the above fees and agree to pay the monthly fee stated above, which is a non-refundable and due in full and on the first of each month.

I have read, understand, and agree with the above Monthly Fee Agreement

By typing and signing my name in the appropriate fields below, I agree to and understand the above statements and that all info stated on here is true. I will pay the monthly fee in a timely manner, and confirm that I agree with the "Terms of Agreement". *

Signature by adult student, parent, or legal guardian required):

_______________________________________________________

Print: _________________________________________________

Date: _______________________

We will print out the form for you to sign.

Please state your relation to the student. *

Self

Parent/Guardian

Other:

Send me a copy of my responses.

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