North Side Karate                                                                                       

Sensei D.E. Chambers, Chief Instructor  .

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Discipline, Respect, Attitude, Self-Assurance, and most of all Honesty

 

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ONLINE STUDENT REGISTRATION

 

Student Registration Forms

  

Printable Forms (Print, Complete, and Deliver or Mail to Dojo)

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Registration Form

Waiver Form

  

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(Requires MS Word 2003, 2007, or 2010)

Registration Form

Waiver Form

  


  

Online Registration Form

(Complete this form for each student being registered)

STUDENT INFORMATION

  

Student Name                              Date of Birth                    Current Age

                                  

  

Has student ever had karate classes?   

If Yes, please list where and highest rank:

Does the student have any physical impairment?   

Does the student currently set goals?   

If Yes, do they achieve them?        If No, would you like them to?   

  

Briefly describe the following information about the student:

    

Personality:

Temperament:

Confidence Level:

Coordination:

Attention Span:

  

If the student was in Karate classes, what areas of improvement would you like to see?

Physical Fitness   Self-Confidence  Coordination     Discipline

Attention Span    Determination      Weight Loss     Posture/Poise/Figure

Positive Attitude  Memorization      Tension Relief   Speed/Perception/Agility

Self-Defense       Perseverance & Endurance

  

PARENT INFORMATION

  

Mother's Name:  

   

Street Address:    City/State/Zip:

  

Home Phone:   Cell Phone:   Work Phone:


Father's Name:  

   

Street Address:    City/State/Zip:

  

Home Phone:   Cell Phone:   Work Phone:


By clicking the submit button below and transmitting this form to North Side Karate, you acknowledge and certify that you have entered all information above completely and accurately.

  

** The registration fee and first month payment are non-refundable.

  

Validation Code:        

[Enter NSK2011 above to help prevent Spam sent through our message server]

   

  

 

 

 

 

 

 

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