Registration - All-Pro TKD

How many students are you registering?*

Name of Student #1*

First Last

Birthday for Student #1*

School for Student #1*

Name of Student #2*

First Last

Birthday for Student #2*

School for Student #2*

Name of Student #3*

First Last

Birthday for Student #3*

School for Student #3*

Name of Student #4*

First Last

Birthday for Student #4*

School for Student #4*

Name of Student #5*

First Last

Birthday for Student #5*

School for Student #5*

Name of Parent/Guardian*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email address*

Mobile Phone*

Work Phone

Safety Information

(Person to contact in case of emergency if parent or guardian is unavailable)

Name

First Last

Home Phone

Mobile Phone

Check all that apply*

Referred by*

Please list any medical conditions we should be aware of:

By checking this box, I (the parent/guardian listed above), agree to the terms below*

I hereby authorize the staff of All-Pro Tae Kwon Do to act for me accordingly to their judgment in any emergency requiring medical attention, and hereby waive and release All-Pro Tae Kwon Do and its staff from any and all liability for injuries or illness incurred while in the studio. I have no knowledge of any physical impairment that may affect the above named student participation in the Tae Kwon Do program, and have read and understand the terms, rules and conditions outlined in the accompanying material including the student enrollment agreement.

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