Application Form
SPENCER GOJU-KAI KARATE-DO
Name:________________________________
Address: ______________________________
Date of Birth: __________
Phone___________ Cell Phone__________________________
Previous Martial Arts training: ____________
How Long? _____________ Rank: ________
Physical concerns?_____
Describe Briefly:_______________________________________
I understand that there is a risk of personal injury with the practice of any martial art. I waive and release Steven or Shirley Chalmers from any liability or illness incurred while participating in any activities provided by the Spencer Goju-Kai Karate-Do. The applicant is in good physical health and able to participate in rigorous physical activity. I have read and understand this release and waiver prior to signing.
Signature: _____________________________ Date: ______
IF UNDER 18
Parent or guardian signature:
Signature: _____________________________ Date: ______
117 Main Street
Spencer, MA 01562 - 508-885-0308
© 2006-2007