Cape Fear Isshin-Ryu SPECIAL EVENTS REGISTRATION FORM

Student
Name:*
Date of Birth:*
MM slash DD slash YYYY
Age:*
Grade:*
School:*
Parents Name (if minor):*
Home Address:*
City:*
State:*
Zip:*
Phone Home:
Phone Work:
Phone CELL:*
Email address:*
In case of emergency, contact:
NAME:*
Phone:*
Relation to student:*
I understand that karate and all other Martial Arts are sports involving physical contact and physical exercise. I am aware that my child is engaging in physical exercise and self-defense instruction. I understand that it is advisable to contact my child’s physician before entering any physical fitness program. My child is voluntarily participating in these activities. In the event I cannot be reached in an emergency, I hereby give my consent to Cape Fear Isshin-Ryu, its instructors, employees, or any Emergency Medical Personnel to administer or secure any necessary treatment to my child in the event of an emergency and transport him/her by ambulance if the situation warrants.
Parent/Guardian Name:*
Signature:*
- Yes
Date:*
MM slash DD slash YYYY

Student