Karate Club of America

INTRODUCTORY MONTH REGISTRATION

Please complete the form below to register for your introductory month of classes. First month is just $59, applies to all locations, and includes a free uniform!

Student Name:
Parent Name: (required if under 18)
E-mail Address:
Street Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Class Start Date: (i.e. mm/dd/yy)	/ /
Class Location:

Please check this box to show that you have read and agree with the
Classroom Rules and Student Waiver & Release.