Cape Fear Isshin-Ryu SPECIAL EVENTS REGISTRATION FORM Special Events Registration StudentName:*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