Karate Program Registration Cape Fear Isshin-Ryu Karate Program REGISTRATION FORM Registration Form 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