Paducah Zen Do Ryu Karate
Enrollment Application
Age: _____ Gender: Male ___ Female ___
Date of application: __________________
Student's Name: ______________________________________
Telephone# ____________________
Date of Birth: _______________________
Height: ________ Weight: ________
E-mail: _______________________
Address: ______________________________________________
City/State: ___________________________
Any previous Martial Arts training: _____ IF yes, please list School(s), Style(s), Instructor(s) & student's Rank: _____________________________________________________________________________________
Any medical problems, difficulties or other
information that the instructor should be awair of:
________________________________________________________________________________
IMPORTANT!
I, the undersigned, fully understand & agree to the following: 1. That this school (instructors, associates, students & Park Avenue Baptist Church) will NOT be held responsible for any injuries incurred on school premises or as a result of training, or of the applying student's own actions. The undersigned further agrees that this school is hereby released from any and all liabilities that may result from actions of any of it's members &/or students, including those of the applying student. Proof of insurance IS required by Park Avenue Baptist Church. 2. That the violation of any of this school's rules &/or regulations by the applying student may result in the suspension or even permanent dismissal of the student at the head instructor's discression. 3. Wheather a student leavs voluntarily or is dismissed, there will be no refunds of any kind; However, at such time, any money owed to, or materials borrwed from this school will become due. 4. The school is not responsable for any damaged, lost or stolen property. Signature of agreement (by parent/guardian or adult student):
__________________________________
