TaeKwon Do Registration

KOH TaeKwonDo Registration

Student Name*

Address*

City, State, Zip*

Mother's Name*

Mother's Cell #*

Mother's Work #

Father's Name

Father's Cell #

Father's Work #

Email Address*

How did you hear about us?*

Does your child have any previous Martial Arts experience? *

If yes, please describe how long, what type and where?

YESNO

Medical conditions we should be aware of:

Does your doctor consent to join TaeKwonDo?*

YESNOI DON'T KNOW

Emergency Contact - if parents cannot be reached:*

Name / Telephone # / Relationship

Electronic Signature:*

Authorization for emergency Medical care in the event of illness or accident if parent/guardian cannot be reached. An original signature is required before or upon 1st day of training. Signature of parents or Legal guardian:

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