Fillable Registration

AUSTIN KENPO KARATE STUDENT ENROLLMENT FORM

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Emergency Contact/Pick Up Information

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1.

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2.

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3.

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4.

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5.

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6.

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7.

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I have read and understand the policies set forth in the Operational Hand Book and agree to the conditions and terms outlined. No other verbal or written modification of these documents exists.

Transportation

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I give permission for my child to be transported and supervised to/from AKK.

Liability Waiver

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Emergency Medical Information and Immunization Records

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Medical History

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CREDIT CARD BILLING AUTHORIZATION

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Program Rates:

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Weeks Child Will Attend (check all that apply):

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Method of Payment (Please refer to Operational Policies for rates):

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Methods to Submit Student Application Form (ALL pages):

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Current student

Internet search engine (Google, Yahoo, MSN, etc.)

Citysearch

Yelp

Other internet review site(s):

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Facebook

Yellow Pages

Friend:

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Other:


AUSTIN KENPO KARATE

5501 N Lamar Blvd,,

Suite A 225,

Austin, Texas 78751

Phone. 512-459-1806

Email. sifuschroder@gmail.com