Alpha Martial Arts Academy

6849 Buffalo Road, Palmetto, FL 34221

(941) 544-5572

JUJUTSU REGISTRATION

DATE:

STUDENT 1 NAME:(Required)

First Last

STUDENT 2 NAME:

First Last

PARENT 1 NAME:(Required)

First Last

PARENT 2 NAME:

First Last

ADDRESS:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PHONE:(Required)

EMAIL ADDRESS:(Required)

EMPLOYER:

EMERGENCY CONTACT: FIRST & LAST NAME(Required)

PHONE:(Required)

PREVIOUS MARTIAL ARTS EXPERIENCE:

PLEASE INITIAL THE FOLLOWING STATEMENTS IN AGREEMENT:

I AGREE THAT I AM AWARE THAT I OR MY CHILD(REN) IS/ARE ENGAGING IN PHYSICAL EXERCISE AND THE USE OF THE EQUIPMENT, FACILITIES, TRAINING, AND INSTRUCTION, WHICH CAN BE DANGEROUS TO THE STUDENT AND COULD CAUSE INJURY TO THE STUDENT. STUDENT IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES AND BUYER AND STUDENT ASSUME ALL RISKS OF INJURY TO STUDENT, WHICH MAY RESULT. BUYER AND STUDENT HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND IT IS A RELEASE OF ALL LIABILITY AND DAMAGE TO ALPHA MARTIAL ARTS FOR ANY INJURY. ALPHA MARTIAL ARTS WILL MAKE NO EVALUATION OR RECOMMENDATION WHETHER STUDENTS OR GUESTS ARE SUFFICIENTLY PHYSICALLY FIT FOR ANY EXERCISE ACTIVITIES.(Required)

Agree

I UNDERSTAND AND AGREE TO THE INFORMATION CONTAINED IN THIS DOCUMENT. I AGREE TO COMPLY WITH THE DETAILS, RULES, AND REGULATIONS HEREIN AND I UNDERSTAND THAT DISREGARDING SAID RULES, REGULATIONS, AND DETAILS MAY RESULT IN TEMPORARY OR PERMANENT SUSPENSION OF THE PROGRAM.

I have read and agree to the liability statement above.

I agree.

STUDENT PRINTED NAME:(Required)

PRINT FIRST AND LAST NAME

DATE:(Required)

PARENT SIGNATURE:

DATE:

GENERAL INFORMATION:

COMPLETE UNIFORM INCLUDING GI AND BELT IS REQUIRED FOR CLASS. NO EXCEPTIONS WILL BE MADE.
ALPHA MARTIAL ARTS ACADEMY DOES NOT ASSUME ANY RESPONSIBILITY FOR THE LOSS, DAMAGE, OR THEFT OF ANY PROPERTY BELONGING TO THE STUDENT.
SUPERVISION – ALPHA MARTIAL ARTS WILL NOT BE RESPONSIBLE FOR SUPERVISION OF ANY CHILD OUTSIDE OF SCHEDULED CLASS.
FOR THE SAFETY OF ALL OTHER STUDENTS AND STAFF, PLEASE REFRAIN FROM COMING TO CLASS IF YOU ARE EXPERIENCING FEVER, VOMITING, DIARRHEA OR LICE.
WHEN A STUDENT’S BEHAVIOR BECOMES INAPPROPRIATE, A WARNING WILL BE ISSUED AND CORRECTIVE MEASURES WILL BE TAKEN. ALPHA MARTIAL ARTS RESERVES THE RIGHT TO TERMINATE ANY STUDENT PARTICIPATION IN ANY AND ALL OF OUR PROGRAMS AFTER THREE CONSECUTIVE WARNINGS OR AT ANY TIME.
ALPHA MARTIAL ARTS RESERVES THE RIGHT TO USE ANY AND ALL IMAGES AND PHOTOS TAKEN IN THE DOJO FOR ANY ADVERTISING OR DISPLAY PURPOSES.

I have read and agree to the liability statement above.

I agree.

CANCELLATION INFORMATION

15 DAYS NOTICE IS REQUIRED TO CANCEL YOUR RESERVATION IN ANY PROGRAM.
A CANCELLATION FORM MUST BE FILLED OUT AND RETURNED TO THE DOJO BEFORE THE 15TH OF THE MONTH FOR CANCELLATION TO OCCUR THE FOLLOWING MONTH.

I have read and agree to the liability statement above.

I agree.

EVENING PROGRAM DETAILS(Required)

BASIC PACKAGE (2 classes per week) $145 PER MONTH

PREMIUM PACKAGE (3 classes per week) $160 PER MONTH

ALL ACCESS (Any and all classes within Belt Rank Restrictions) $175 PER MONTH

Please choose the program that best fits the student. You will be charged program tuition on the first day of class. For partial months tuition will be prorated.

PLEASE ENTER YOUR CREDIT CARD DETAILS FOR MONTHLY PROGRAM TUITION(Required)

CREDIT CARD EXPIRATION DATE CVV ZIP CODE

REGISTRATION FEE $99.00 *INCLUDES GI(Required)

Price:

Date

PAYMENT INFORMATION

TESTING FEES ARE SEPARATE FEES THAT WILL BE COLLECTED BEFORE BELT TEST.
THERE WILL BE A LATE FEE OF $20 FOR PAYMENTS MADE AFTER THEIR DUE DATE.
NO CREDITS OR REFUNDS CAN BE ISSUED ON SERVICES, EQUIPMENT, UNIFORMS, OR UNUSED (MISSED) DAYS.
DEFAULT IN PAYMENT RESULTS IN CANCELLATION OF PROGRAM. THE REMAINING BALANCE SHALL BE DUE AND PAYABLE AS WELL AS THE COST OF COLLECTION, COURT COSTS, AND ATTORNEY FEES.

Credit Card(Required)

Cardholder Name

Card Details