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ACTION KARATE
MARTIAL ARTS

A Black Belt School Building Character

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- Mt. Airy
- Collingswood
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Athlete Intro - Collingswood

Adult #1 First Name

Adult #1 Last Name

Adult #1 Email

Adult #1 Cell Phone

Street Address

City

State

Postal / Zip code

Adult #2 First Name

Adult #2 Last Name

Adult #2 Cell Phone

Number of Participants

Person #1 First Name

Person #1 Last Name

Person #1 Birthdate

What primary benefit would you or your child like to achieve at Action Karate?

Person #2 First Name

Person #2 Last Name

Person #2 Birthdate

What primary benefit would you or your child like to achieve at Action Karate?

Person #3 First Name

Person #3 Last Name

Person #3 Birthdate

What primary benefit would you or your child like to achieve at Action Karate?

Person #4 First Name

Person #4 Last Name

Person #4 Birthdate

What primary benefit would you or your child like to achieve at Action Karate?

Person #5 First Name

Person #5 Last Name

Person #5 Birthdate

What primary benefit would you or your child like to achieve at Action Karate?

Are there any activities that could conflict with training? (IE: Soccer, Dance, Swimming) Please list:

Have you trained in martial arts in the past? *

Yes

No

How did you hear about us?

Tuition is approximately $69-$79 weekly. Is this in your budget for Martial Arts (life skill) education? *

Yes

No

Maybe

If you are happy with our program, are you prepared to enroll today? *

Yes

No

(Program Adherence) Please check each box to indicate you have read Action Karate's Program Requirements and Expectations.

I will make sure to come to class on time and in the appropriate uniform.

I will see an instructor with any challenges so we can work together to help reach our family's goal

I understand that growth is at times challenging. I will commit to the program.

Member represents being physically fit to take the prescribed program. All use of the facilities shall be under taken at the sole risk of the member. The school/Action Karate shall not be liable to the member for claims, demands, and injuries, loss of property or acts of negligence. Participant agrees to receive emails/texts from Action Karate.

I agree

Athlete #1 Class

Athlete #2 Class

Athlete #3 Class

Athlete #4 Class

Athlete #5 Class

Action Karate Mt. Airy

(267) 282-1170

11 W. Mt. Airy Ave

Philadelphia PA 19119

Action Karate Collingswood

(856) 210-9002

1 West Wayne Terrace

(Haddon Ave Entrance)

Collingswood NJ 08108

Action Karate Headquarters

©2022 by Action Karate Mt. Airy.

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