Fall 2019 Semester Registration
Choose Your School *
Required
Choose Your Program *
Choose Your Class Options
Email Address *
Your answer
Telephone # *
Your answer
Student First Name *
Your answer
Student Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Main Dojo Class Options & Fees by Program
I understand I am making a financial commitment to an entire semester of classes (Aug - December) *
Required
I understand that semester tuition is paid in equal installments – NOT a month-to-month basis. *
Required
I understand installments are due on the 1st of each month, regardless of student's absence, major holidays, and or school holidays *
Required
I understand that I will be liable for the entire semester cost if I cancel or quit classes *
Required
VIP PASS OR MONTHLY INVOICE *
Required
Liability Waiver
Black Belts For Christ Ministries, Inc. is insured by the Francis L. Dean & Associates, Inc. Insurance agency. Although all precautions have been taken to insure the safety of all participants, every student must complete this form. In consideration of being allowed to participate in any way in any Black Belts for Christ Martial Arts program, and related events and activities, the participant and parent or guardian: 1. Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating, he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she will immediately advise Black Belts for Christ Ministries personnel of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. 4. Release, waive, discharge and covenant not to sue Black Belts For Christ Ministries, Inc., Regency Christian Academy, and their affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees" from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 5. In addition, I hereby grant full permission to any all of the foregoing to use any photographs, videotapes, motion pictures, or any recordings for any purpose. I have fully read and understand this release and waiver.
Full Name of Parent/Guardian Submitting this Registration (Same if Adult Student) *
Your answer
Upon registration you will receive an invoice reflecting your class choices and Membership Level. Example:
SAMPLE INVOICE
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