Minor Student Registration Form Minor Student Registration Form Date: * Student Information: Name * Street Address * City * State * Zip * Date of Birth * School * Cell Phone * Email * Parent(s) or Guardian(s) Name (Emergency Contact Information): Name * Address (If different from student) Cell Phone * Email * Name Cell Phone Email Preferred way to be contacted: Contact Mode * Phone Text Email Reason for interest in Tang Soo Do: * Any previous experience in the martial arts? Experience in marital arts * Yes No If yes, what style? * What level of rank did the student obtain? * Why did the student stop? * Does the student have physical or mental health issues? physical or medical problems * Yes No If yes please explain * Safety is the most important aspect of our class. It is the responsibility of each student as well as instructors to uphold safety. Although safety is our number one priority, accidents and injuries may still occur. Please sign and date this document and return it to us before entering your first scheduled class. Read it very carefully before you sign. By signing this document, you agree to accept the risk involved in martial arts training and the following: In the event of an accident involving me (or my minor child) I hold myself (or my minor child) responsible and not my instructors, fellow students, property owners or the staff of Karate USA. I will not hold anyone responsible, not now, or anytime in the future due to accidents or injuries incurred on or off this property, during training of any kind related to Karate USA or any affiliates of the Independent Tang Soo Do Association. Student Signature * Parent or Guardian Signature * If you are human, leave this field blank. Submit