Join Us

Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Classes

Select which classes you'll be attending

Monday 4:45pm - 5:30pm - Kids Class (6-9 years old)

Monday 6:30pm - 7:15pm - Red belts - Junior Black belts

Monday 7:15pm - 8:30pm - Senior black belts

Wednesday 4:00pm - 4:45pm - Beginners Class (4-5 years old)

Wednesday 4:45pm - 5:30pm - Kids Class (8-10 years old)

Wednesday 5:30pm - 6:15pm - Kids Class (11-13 years old)

Thursday 4:00pm - 4:45pm - Kids Class (5-7 years old)

Thursday 4:45pm - 5:30pm - Kids Class (7-9 years old)

Thursday 5:30pm - 6:15pm - Kids Class (10-12 years old)

Thursday 6:30pm - 7:15pm - Brown belts - Black belts

Thursday 7:15pm - 8:30pm - Senior Black belts

Saturday 7:00am - 8:30am - Black belts outdoor training

Parent Name

Only required under 18 years old

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile

(###)

###

####

Health Declaration *

Have you suffered any incapacity requiring medical attention in the past 12 months?

Yes

No

Do you have any health issues that you are aware of *

Yes

No

Do you suffer from asthma or are you anaphylactic? *

Students must bring their medications with them to ALL training sessions. This includes ASTHMA PUFFERS and EPIPENS. Students should inform their instructors of their condition before training.

Yes

No

Martial Arts history *

Have you ever been a member of another Martial Arts club?

Yes

No

Consent *

I hereby certify and decree that all information contained in the declaration above is true and correct. By clicking 'SUBMIT', I agree to be added to the Jeffsan Karate database.

I agree

I disagree

Waiver *

You are advised of the inherent risk and the participation commitment expected by submitting this form and taking part in Jeffsan Karate activities. You knowingly accept that risk and commitment for yourself and/or your child, and absolve Jeffsan Karate of any injury, physical or otherwise that may result due to these inherent risks and participation commitment.

I understand

Payments *

I hereby acknowledge that the fee structure has been understood by me and payments will be made in advance. On termination there is a ONE month notice period.

I agree