Introduction to Martial Arts Classes
Spring 2016 Registration Form
Six Weeks of Tang Soo Do Classes
Friday Classes: April 8th – May 13th
[ ] 4:30pm-5:30pm or [ ] 5:30pm-6:30pm
Ages5-12yrs
$40 (no uniform) $55 (uniform included)
Instructed by: Master Trapper Taylor
Has your child ever participated YMCA Martial Arts?
Yes or No
Would your child like to purchase a uniform? Yes or No
School:________________________Height:_____________Weight:_____________
Childs Name:______________________________Age:______________D.O.B:_________________________________
Parents Name:____________________________________________________________________
Address:___________________________City:_______________State:_______Zip Code:_______
Phone:_____________________________ Alternate Phone:_______________________________
Emergency Contact: ___________________________Phone:_______________________________
E-Mail:___________________________________________________________________________
Medical or Behavioral Information:
_________________________________________________________________________
Please Read and Sign:
WAIVER OF LIABILITY: I fully assume and understand the risks of my child participating in Martial Arts class including obstructions,
sudden illness, death or injury, and all other risks. I attest that my child is physically fit to participate. I authorize program staff to
provide medical attention at my expense should my child appear in need. For injuries my child sustains, including death, I agree to save
and hold harmless the YMCA of Avery County, volunteers, program staff, suppliers, contractors and anyone else connected with the
organization of this program, from any claim or lawsuit that may be brought at any time be me, my family, estate, heirs or assigns,
arising from my child’s participation in this program or the instruction received.
WAIVER FOR PUBLICITY: I agree that images taken of my child during this program may be used in any legal manner without payment to
me. I have read and understand the terms of this document. I make this agreement and pay the program fee in exchange for the privilege
of my child participating under the conditions of the program.
Parent/Guardian Signature: __________________________________Date:___________________
Office Use Only
Receipting Clerk: _________________________________________________Date:_______________
Total Amount Paid: _______________________________________________Staff Initials: ________