ANCHS WEREWOLVES REGISTRATION

FORM
☞ REGISTRATION DATE:

☞ Membership ID Number T –

☞Please write very clearly

Student Name (Last) (First)

Date of Birth (Month) (Date) (Year) Sex M F

Address

Phone Home: E-mail:

Attending School

Parent Information (Last) (First)

Mobile: E-mail:

Emergency Contact (if different above)

Name: Tel:

Any medical concerns

How did you hear about us?

Have you ever done Martial Arts before? Yes No

If yes, When was the last time? __________ Where? ______________

For how long? ___________

What other activities are you currently involved in?________________________

Do you have any health conditions or injuries we need to be aware of?

Please explain:

Why do you want to learn Martial Arts? Please select up to three reasons below:

Self Defense Self Confidence Fitness To compete Social Activity

Reduce Stress Self Discipline Fun To learn Martial Arts

Other, please explain:

______________________________________________________________
♣ Terms and Conditions
I and my child is fully recognize the risks of injury inherent in participating in any fitness or martial
arts program, and we represent to the ANCHS WEREWOLVES TKD academy that we have taken all
reasonable steps to determine that we are in good health and physically capable of participating in the
programs and courses of instruction offered by ANCHS WEREWOLVES TKD. We acknowledge that the
ANCHS WEREWOLVES TKD shall make no, and shall have no responsibility to make any independent
evaluation of our physical health or fitness. We understand and agree that all participation in any such fitness
program or use of the ANCHS WEREWOLVES TKD’s facilities or equipment on or off the premises of the
ANCHS WEREWOLVES TKD shall be at our own risk.

FOR PARENTS/GUARDIANS:

By signing this Liability Waiver, I fully recognize and acknowledge that TaeKwonDo is a contact sport and may
result in physical injury to my child/ward. Having a full understanding of these risks, I permit my child/ward to participate
in the classes. I assume full and complete responsibility for any and all damages or injuries that he or she may sustain or
incur, if any. I do hereby release and further discharge ANCHS WEREWOLVES,TKD, any assistant instructors, or
employees, for any personal injury that my child/ward may sustain while attending any class or activity. I also realize and
acknowledge that I am solely responsible for any medical attention or treatment that my child/ward may need because of
his/her participation.

___________________________________ ___________________________________
Date Parent / Guardian Name

___________________________________ ___________________________________

Date Guardian/Student Signature