After School - Cape Fear Isshin-Ryu Karate

Cape Fear Isshin-Ryu After School Karate Program REGISTRATION FORM

Our after school program is being offered for children ages (5-14) between 2:00-6:15 P. M., Monday through Friday. Transportation is available from specified local schools to Cape Fear Isshin-Ryu Karate & Afterschool Program. There will be designated time for homework, Karate instruction, snacks and games.

Registration Form for Cape Fear Isshin-Ryu After School Program

I agree to waive any and all claims against persons connected with Cape Fear Isshin-Ryu Incorporated.
As we are aware, very young children are prone to mishaps. Although we will give every effort to have adequate supervision, occasionally accidents will happen. In the instance that an emergency arises we would consider this form your specific permission to transport and have your child treated by a professional caregiver/physician, etc. This form also serves as specific permission to pick your child up from their respective school and transport them back to our dojo for our karate after school program. Cape Fear Isshin-Ryu reserves the right to remove any child from the program. This is for the safety and well being of all students and staff.

NO REFUNDS AFTER REGISTRATION

2 WEEKS WRITTEN NOTICE IS REQUIRED IF YOU WISH TO WITHDRAW FROM THE PROGRAM

Please print and fill out, or submit online.

Student Information:
Student Name:*
School:*
Grade:*
Date of Birth:*
MM slash DD slash YYYY
Parents Name:*
Home Address:*
Phone Home:
Phone Work:
Phone CELL:*
Email address:*
Emergency contact, NAME:*
Phone:*
Relation to student:*
Family physician name/address/phone #*
Insurance Company:*
Policy #*
Phone #*
Date:*
MM slash DD slash YYYY
Parent Signature:*
- Yes
Transportation Permission:
From time to time, it may be necessary to transport a camper/after school Student to an event or from school via staff passenger vehicle. Therefore, we must have your permission to transport your child in such vehicles as circumstances warrant. Your signature below authorizes us to do so as required. In addition, I authorize my child/children to be transported to and from camp activities/school via Cape Fear Isshin-Ryu Incorporated vehicles. By signing this, I am also giving my permission to send my child/children on any prearranged field trips.
Parent Signature:*
- Yes
Date:*
MM slash DD slash YYYY

Cape Fear Isshin-Ryu After School Karate Program REGISTRATION FORM

Registration Form for Cape Fear Isshin-Ryu After School Program

NO REFUNDS AFTER REGISTRATION

2 WEEKS WRITTEN NOTICE IS REQUIRED IF YOU WISH TO WITHDRAW FROM THE PROGRAM

Student Information:

Transportation Permission: