[FITNESS, SPORTS & RECREATION] Martial Arts Registration + Recurring Monthly Payments

Welcome to [ENTER ORGANIZATION NAME]. Please complete the following information. [ENTER ORGANIZATION NAME, ADDRESS] Phone: (123) 456-6789 Email: YourName@YourEmail.com Website: YourWebsite.com

1Student 1 > 2Additional Students
Typical Children's Karate Class
Our Location
Parent or Guardian name (if student(s) registering are under 18 years of age) First Last
Home phone - ### - ### ####
Best phone number to reach you - ### - ### ####
Email Address
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Address
Address Type Street Address Address Line 2 Apartment City State / Province / Region Postal / Zip Code Country
STUDENT 1 INFORMATION

You can register up to 3 students using this form.

NOTE: If you are only registering one student, complete the information below for Student 1, then scroll down to the bottom to read our Terms & Conditions, sign, and submit your registration.
Student 1 name * First Last
Student 1 date of birth (DD/MM/YY) *
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Student 1 age *
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Student 1 Health Card number *
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Confirm Email *
Student 1 phone number * - ### - ### ####
Student 1 email address
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Please select the following objectives for Student 1: *
Anger management Courtesy through martial arts Develop leadership abilities Develop positive attitude Developing character Developing positive attitude Healthy lifestyle habits Improve academic achievements Improve communication skills Improve concentration & focus Increase self-confidence & self-esteem Learn skills for success Lose weight Meet new friends Motor skills development Peer pressure management Physical conditioning Reaching goals and objectives Release energy Relieve tension Respect for self and others Self-defense Self-discipline
Does Student 1 have any physical, behavioural, or medical concerns that we should be aware of? (strictly confidential)
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Which program is Student 1 registering for?
(You will be redirected to PayPal Checkout to complete payment after you submit this form. Monthly fees will automatically be withdrawn from your PayPal or credit card) *
Novice Dragons (ages 4-6): $30 per month Experience Dragons (ages 4-6): $60 per month Junior Karate (ages 7-10): $70 per month Jiu-Jitsu (ages 11-15): $75 per month Women's Kickboxing (ages 16+): $80 per month Men's Kickboxing / Kenpo Karate (ages 16+): $85 per month
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[FITNESS, SPORTS & RECREATION] Martial Arts Registration + Recurring Monthly Payments

[FITNESS, SPORTS & RECREATION] Martial Arts Registration + Recurring Monthly Payments

STUDENT 1 INFORMATION

$0

Total

$`0`