Youth Registration Form

East Coast Wado Karate Youth Registration

Complete the form below to register your child for class.
Child's Name*

First NameLast Name
Birth Date:

MonthDayYear
Belt Level*
Parent's Name*

First NameLast Name
E-mail*

Confirmation Email
Phone Number:*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Fee Payment Agreement and Acceptance of Risk
I have read and received the fee payment policy and agree to pay all fees as outlined. All cheques are payable to East Coast Wado Karate Club.There is a potential risk for injury involved in training and participating in any sport. East Coast Wado Karate Club has tried to create a safe and controlled environment for safe participation. This agreement releases East Coast Wado Karate Club from all liability relating to injuries that may occur during training. By signing this agreement, you agree to hold East Coast Wado Karate club entirely free from any liability, including financial responsibility for injuries incurred, regardless whether injuries were caused by negligence.
Photo Permission
I give permission for my child to be photographed or filmed by media and have these images be used for ECWKC publicity needs including website, print and other publications.
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East Coast Wado Karate Youth Registration