New Student Enrollment - Rocky Silva's American Karate

Student's Name *

First

Last

Student's Date of Birth *

MM/DD/YYYY

Parent/Guardian Name *

First

Last

Primary Phone Number *

Secondary Phone Number

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Uniform Size

Size Chart
https://www.boldlook.net/size-charts/

Allergies and/or medical history relevant for training

How did you hear about us? *

Who was it that referred you?

If other, fill in below

Waiver Agreement

I agree to the below waiver

By checking this box, and in consideration for my attendance and participation in this academy’s martial arts training, I, the student/parent, acknowledge the existence of certain inherent risks in this type of activity and hereby agree to assume all risk. I further relieve the academy, its management, assigned staff, and fellow students, from any liability resulting from personal injury, damage, or similar. I also hereby state that the guests named above are physically fit to take the prescribed course of instruction and do so of their own free will. This applies to both in person and virtual training.

Little Champions (Ages 5-6)

Kids Karate (Ages 7-12)

Adult Martial Arts