Seven Star Dragons North Avondale Recreation Center 2017 Sign-Up Sheet
This is the sign-up sheet for North Avondale Recreation Center's Seven Star Dragons Karate Classes.
Seven Star Dragons: North Avondale Recreation Center Dojo
New Student or Renewal? *
Name of Student (Last, First) - If under age of 18, please add name of parent/guardian below. *
Your answer
Name of Parent/Guardian (Last, First)
Your answer
Relationship to Student
Your answer
Phone Number (XXX) XXX-XXXX *
Your answer
Emergency Contact Name & Phone Number (if different from parent/guardian)
Your answer
Mailing Address *
Your answer
Zip Code *
Your answer
E-mail Address *
Your answer
Student/Parent/Guardian Employer *
Your answer
Occupation *
Your answer
Employer Address *
Your answer
Age of Student *
Your answer
Name of School Attending (if applicable)
Your answer
Which grade or college/university/trade school?
Date of Birth *
MM
/
DD
/
YYYY
Height (X'X") *
Your answer
Weight *
Your answer
Sex *
MEDICAL: Does the student have any physical, emotional, or medical conditions that the instructor should be aware of? (e.g. allergies, ADHD, joint problems, asthma, etc.) If yes, please explain. If no, type "None." *
Your answer
Preferred Doctor & Phone Number
Your answer
Preferred Hospital & Phone Number
Your answer
Preferred Dentist & Phone Number
Your answer
Please list parents/guardians (including phone number) with permission to pick up your child if not already provided.
Your answer
Select the classes that will be attended *
Required
Tuition / Fees
Please contact us for affordable programs we have to offer. We will contact you and make a new members appointment. We are looking forward to serving you.
Waiver & Authorization to Use Media
Registrant (student) and parent or guardian warrant, represent, and agree that student is in good physical condition and has no disability, ailment, or impairment that would be detrimental or inimical to student's safety, comfort, or physical condition if student so engages or participates. Student participates in the Seven Star Dragons, karate, fitness & discipline program at student's own risk. Student assumes full responsibility for any injuries, damages, or losses, which may occur to student or guest of student's. Students expressively agree that Seven Star Dragons karate School, CPS Enrichment Programs, its owners, agents, employees, instructors, students, volunteers, corporate affiliates, associated clubs, CRC and athletic organizations shall not be liable to student and/or student's guest for any damages, losses, any injuries or any thefts of personal property at or around the training site or off site. Student hereby fully and forever releases and discharges the aforementioned from any and all claims, demands, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, resulting from or arising out of students participation or guest's attendance during participating in the program on or off training site.

I grant consent for my child or self to be photographed or videoed when participating. I also grant consent for the use of video and photographs taken while a participant to be used for advertisements, training materials, and publicity without compensation. I will be responsible for putting in writing any objections to using myself or child in use of photographs or videos made while active in Seven Star Dragons Karate Programs.

Please note: I and/or Parent/Guardian understand that by signing up for classes at North Avondale Recreation Center, upon visiting class and/or scheduling an appointment to discuss cost, will be provided with written information regarding program costs and code of conduct while participating in this program.

Please download the North Avondale Recreation Center Karate Agreement at the following link, sign it, and bring it to class: https://goo.gl/9gM8nV

I have read and understood the North Avondale Recreation Center Karate Agreement. *
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