Online Registration Form – South Coast Karate

Please complete the registration below. (Versión en Español)

Participant Information

Student First Name

Student Last Name

D.O.B.

School

Parent/Guardian Information

First Name

Last Name

Relationship

Mother/Father etc.

Contact Information

Street Address

State

City

Zip Code

Email Address

Phone

The best number to contact you

Emergency Contact Information

First Name

Last Name

Phone

Additional information that the we should be aware of?

I, the adult student, or guardian of the minor student listed above, do consent and agree that SOUTH COAST KARATE ORGANIZATION, and any sponsoring organization, facility instructor, and any other party involved are hereby released and held harmless from all claims and liability due to any injuries and/or damages I may suffer as a result of ordinary negligence or carelessness including the risk that are incidental to the participation in the karate program. Student and/or guardian is familiar with the risks associated with this sports program and assumes these risks. It is acknowledged that negligent and even careless conduct is an inherent risk of this sport.

It is further agreed that student or guardian will defend, indemnify and hold harmless SOUTH COAST KARATE, and its employees, from any claims arising from injury caused by student.

The Undersigned hereby grants the SOUTH COAST KARATE ORGANIZATION, without expectation of compensation of any kind, the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic portraits or pictures.

I hereby warrant and certify that I am the parent or guardian of the Minor, and do hereby give my consent, without reservation, to the foregoing on behalf of the Minor.

Agreement

The above terms constitute a contract. By checking this box you agree to enter into an electronic contract with South Coast Karate the terms and conditions of which are stated above.

Download and print the Registration Form (English & Spanish)