Soaring Kidz Program Registration: Taekwondo - Winter 2017
Child's Name *
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Date Of Birth (mm/dd/yyyy) *
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Age *
Your answer
Registration Sport *
Shirt Size *
Mother’s Name
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Father’s Name
Your answer
E-mail *
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Primary Phone *
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Secondary Phone
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Address *
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City *
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State *
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Zip Code *
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Child Diagnosis *
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Child’s Doctor *
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Emergency Contact *
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Emergency Phone *
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Please read and respond to the following to help us serve your child better *
(Check All That Apply)
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Please provide any helpful strategies for our staff to assist your child in adjusting:
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How does your child communicate? *
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Are there any other special considerations you would like us to know?
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Has there been any changes in your child’s medical condition or status since the previous program?
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MANDATORY PHYSICIAN RELEASE MUST BE COMPLETED AND RECEIVED BY SOARING KIDZ TO PARTICIPATE
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