After reg

Please describe what day and what time you want for your child.
*
Student Name -1
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Birth date: (MM/DD/YY)
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Student Name -2
Birth date: (MM/DD/YY)
Student Name -3
Birth date: (MM/DD/YY)
Parent/Guardian’s Name
*
Address
*
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Phone Number
*
Email Address
*
School Attended
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THE FOLLOWING IS REQUIRED TO BE ATTACHED TO THIS FORM (Parent to check box indicating task is complete)
*

I have read, understood, and agreed to the Liability Waiver form. The above information is true to the best of my knowledge.
Copy of child’s Immunization Form
EMERGENCY CONTACT NAME
*
EMERGENCY CONTACT Phone Number
*
Physician Name
Physician Phone Number
Health Insurance Company Name
Policy Number
Health Insurance Company Phone Number
Does the Participant take Medication

YES
NO
If YES, name the medication, dosage, times given and doctor’s name and contact number in the space provided below.
I am aware of and agree to (please check by each)
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Program Regulations
Student Regulations
Homework, Weather and Release policy
Snacks, Change, Illness, Medication and Injuries policy
Photo policy
The following people are authorized to pick up your child from our facility. All identified persons MUST present a photo ID before picking up your child. Please identify all persons authorized for pick up
Date
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STUDENT INFORMATION

EMERGENCY CONTACT

PARENT ACKNOWLEDGEMENT

When you press the submit button, we will send you an online invoice. After signing up, you will need to stop by our studio or use the online link to pay for the whole payment. Thank you.

• Provide their own water, snack. (Water and snack must last them the whole day)

If a student cannot follow these precautions, they cannot attend. We are taking these rules very seriously and will not tolerate any misbehaving. If your child gets more than three warnings for not listening, you will be called to pick them up immediately.
When picking up and dropping off your child, please do not come inside. We will have your child ready to leave, all you need to do is knock on our side door and we will send them out!

golden eagle taekwondo

STUDENT INFORMATION

PARENT ACKNOWLEDGEMENT

Tuition.

Registration $50

Monthly $375

weekly $100

Pick up time until

6:00 p.m.