Youth Registration Form

East Coast Wado Karate Youth Registration

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

First Name Last Name
Birth Date:

Month Day Year
Belt Level *
Parent's Name *

First Name Last Name
E-mail *

Confirmation Email
Phone Number: *

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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.
Enter the message as it's shown *
Should be Empty:

East Coast Wado Karate Youth Registration