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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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5.

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7.

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Transportation

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Liability Waiver

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Emergency Medical Information and Immunization Records

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Medical History

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AUTOMATIC CREDIT CARD BILLING AUTHORIZATION FORM (MERCHANT #64959781)

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Registration Fees (Check One):

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Discounts (check one):

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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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Cardholder Address:

Methods to Submit Student Application Form (ALL pages):

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AUSTIN KENPO KARATE

5501 N Lamar Blvd (Temporary Closed)

Suite A 225,

Austin, Texas 78751

AUSTIN KENPO KARATE

8650 Spicewood Springs Road ,

Suite 103,

Austin, Texas 78759

Phone. 512-459-1806

Email. sifuschroder@gmail.com