Southern Hills Dojo
Anadarko, Ok
Enrollment FormKOBUDO A.K.I.'S E-Mail is KOBUDO ANADARKO INSTITUTE OF KARATE ENROLLMENT FORM BEGINNING STUDENTS Copy and mail this form with your application, required $ 50.00 fee and your video. NAME:_______________________________________________________ LAST ----------- M.I. --------------- FIRST ADDRESS:________________________________________ PHONE:___________________ AGE:_____________________ SEX:____ HEIGHT__________ WEIGHT: ________ LBS. DATE OF BIRTH: ________ LIST ANY PREVIOUS MARTIAL ARTS TRAINING :____________________________________________________________________________________________________________________________ CIRCLE YOUR INTERESTS: KARATE - JUDO - JUJITSU - NINJUTSU - WEAPONS KOBUDO **************** IF THIS APPLICATION IS ACCEPTED I WILL FOLLOW THE RULES SET DOWN BY THE SCHOOL, AND I WILL CONDUCT MYSELF PROPERLY IN MY RELATIONSHIP WITH MY FELLOW STUDENTS. I UNDERSTAND THAT MARTIAL ARTS IS A SERIOUS BUSINESS AND SAFETY IS AT ALL TIMES A PRIMARY CONSIDERATION. I REALIZE THAT THERE IS AN AMOUNT OF RISK OF PERSONAL INJURY IN THIS OR ANY SPORT. I WILL NOT HOLD THE SCHOOL (ANADARKO INSTITUTE OF KARATE) RESPONSIBLE FOR ANY SUCH INJURY. ******************* THE SCHOOL WILL MAKE EVERY EFFORT TO CONDUCT ALL TRAINING IN SUCH A MANNER AS TO INSURE THE SAFETY OF ALL PARTICIPANTS. ****************** ANY AND ALL VIOLATIONS OF SAFETY OR CONDUCT RULES WILL RESULT IN IMMEDIATE TERMINATION OF ALL STUDENTS PRIVILEGES - THIS DETERMINATION WILL BE MADE BY THE AUTHORIZED HEAD OF THE SCHOOL. STUDENTS IF UNDER LEGAL AGE MUST HAVE DATE :________________ SIGNATURE OF PARENT OR LEGAL GUARDIAN. STUDENT :_____________________________ ________________________________ SIG. INSTRUCTOR :_________________________ ________________________________ RELATIONSHIP CONFIDENTIAL RECORD ANY PHYSICAL PROBLEMS ON BOTTOM OF FORM, LIST ANY MEDICATION BEING TAKEN. LIST ANY EXISTING CONDITIONS - SUCH AS BLOOD PRESSURE, DIABETES, ETC. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
KOBUDO
NAME:_______________________________________________________
LAST ----------- M.I. --------------- FIRST
ADDRESS:________________________________________
PHONE:___________________ AGE:_____________________ SEX:____
HEIGHT__________ WEIGHT: ________ LBS. DATE OF BIRTH: ________
LIST ANY PREVIOUS MARTIAL ARTS
TRAINING :_________________________________________________________
___________________________________________________________________
CIRCLE YOUR INTERESTS: KARATE - JUDO - JUJITSU - NINJUTSU - WEAPONS KOBUDO
IF THIS APPLICATION IS ACCEPTED I WILL FOLLOW THE RULES SET DOWN
BY THE SCHOOL, AND I WILL CONDUCT MYSELF PROPERLY IN MY
RELATIONSHIP WITH MY FELLOW STUDENTS. I UNDERSTAND THAT MARTIAL
ARTS IS A SERIOUS BUSINESS AND SAFETY IS AT ALL TIMES A PRIMARY
CONSIDERATION. I REALIZE THAT THERE IS AN AMOUNT OF RISK OF
PERSONAL INJURY IN THIS OR ANY SPORT. I WILL NOT HOLD THE SCHOOL
(ANADARKO INSTITUTE OF KARATE) RESPONSIBLE FOR ANY SUCH INJURY.
THE SCHOOL WILL MAKE EVERY EFFORT TO CONDUCT ALL TRAINING IN SUCH A MANNER AS TO INSURE THE SAFETY OF ALL PARTICIPANTS.
ANY AND ALL VIOLATIONS OF SAFETY OR CONDUCT RULES WILL RESULT IN IMMEDIATE TERMINATION OF ALL STUDENTS PRIVILEGES - THIS DETERMINATION WILL BE MADE BY THE AUTHORIZED HEAD OF THE SCHOOL.
STUDENTS
IF UNDER LEGAL AGE MUST HAVE
DATE :________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN.
STUDENT :_____________________________
________________________________
SIG.
INSTRUCTOR :_________________________
RELATIONSHIP
CONFIDENTIAL
RECORD ANY PHYSICAL PROBLEMS ON BOTTOM OF FORM, LIST ANY
MEDICATION BEING TAKEN. LIST ANY EXISTING CONDITIONS - SUCH AS
BLOOD PRESSURE, DIABETES, ETC.