HOMEABOUT USPROGRAMSSTUDENT/MEMBERSREGISTRATION REGISTRATION Please enable JavaScript in your browser to complete this form. - Step 1 of 2Name *FirstLastNick NameDate of Birth *Sex *MaleFemaleGrade1st2nd3rd4th5th6th7th8th9th10th11th12thSchool AttendingParent's Name if Student is Under 18FirstLastHome Address *Address Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Home PhoneCell Phone *• 10% Discount for Military Families • Multi-family Discounts as well • Monthly Tuition $99 for first studentRegistration fees (Initial Month's Fee) are $150 per student and include a uniform and other training aids, textbook, etc.Goals: What specifically would you like to accomplish in our martial arts program?Do you have any medical concerns we should be aware of?For my participation in this program I agree to pay *Per *WeekMonthFor *1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsRegistration Fees (First Month's Fee)Price: $150.00Initial$0.00NextMedical InformationInsurance CompanyPolicy NumberDoctor's NameList any special needs or restrictions/allergiesEmergency Contact Name *FirstLastEmergency Contact Phone Number *Please label each column in order of importance to you (from #1 to #4)Health *#1#2#3#4Physical FitnessStress ReductionRelaxationAppearance *#1#2#3#4Weight ControlMuscle TonePosturePerformance *#1#2#3#4EnduranceFlexibilityMental FocusSelf-Defense *#1#2#3#4SafetyConfidenceAwarenessLiability WaiverBy signing this document, I (we) agree to the following terms: In case of illness or accident, MADDEN TAEKWONDO ACADEMY/REAL LIFE CHURCH (otherwise known as MTA/RLC) and STAFF is authorized to secure emergency medical treat- ment at my expense. MTA/RLC and STAFF reserves the right to dismiss any participant who does not show respect for the facility, including but not limited to property, equipment, policies, other members, and staff. Members who are dismissed will not be given a refund of fees paid. MTA/RLC and STAFF assumes no responsibility for personal property that is either in or out of doors. By signing this Form, I (we) hereby waive any and all claims against MTA/RLC and STAFF. I understand that use of the facilities and equipment at MTA/RLC may involve risk of bodily injury or property damage and I agree to assume any such risks. I understand that it is up to me to consult physicians and other professionals to make sure that the person registered above can safely participate in activities and events at MTA/RLC. I also understand and agree that by signing this Agreement, I am giving up my (or the minor for whom I sign) right to make any claim against MTKDA/RLC its agents, employees, and volunteers, including the right to sue them, for bodily injury or property damage or any other loss that I might suffer while using MTKDA/RLC facilities and services, except as limited by law.Signature *Clear SignatureDate *Submit Contact Us Email maddentkd@gmail.com Find Us Copyright ©2024 Madden Taekwondo | Powered by sba