Aikido Enrollment Form

Student Information
Student Name*

First NameLast Name
Student's Gender*
Student's Birthday*

MonthDayYear
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact E-mail*
Phone Number*

Area CodePhone Number
Previous Martial Arts Experience
Consent/Waiver of Liability/Release
This document must be submitted by the student or the parent/guardian if the student is a minor.

Every precaution will be taken to always insure the safety and protection of our students. However, the study of martial arts is a physically demanding exercise in which accidents or injuries are possible. I agree that Aim and Focus Karate Inc. is not liable for any injuries that occur during training. Aim and Focus Karate does not carry accident medical coverage insurance. It is the sole responsibility of all students to have the proper medical insurance coverage. If an accident does occur, the instructor will contact the Emergency Contact and/or call 911.
Electronic Signature*
Date of Approval*

MonthDayYear
Emergency Contact Information*
Payment Preference
Forms are available at the Front Desk to provide Credit Card or ACH Transfer information. This information is treated as highly confidential.
Options*

Monthly Invoice (e-mail, pay cash or check)Credit / Debit Card (automatic)Bank EFT (automatic)Visiting ONLY
Should be Empty: