SFA Family Martial Arts Registration Form

Fall 2008: 15 Classes (August 25 – December 15)

** NO CLASS 9/1& 9/29 **

(PLEASE PRINT)

 

Monday Classes (check one)

6:15pm – 7:00pm (ages 5-7)* ______     7:00pm – 7:45pm (ages 8-11) ______       7:45pm-8:45pm (ages 12-Adult) _______

Name (Last, First, Middle Initial): ____________________________________

Date of Birth: _____________     Gender (M/F): ____ Grade (Fall 08)*: _________

1st Student Fee = $75

* MUST BE ENROLLED IN 1st GRADE OR HIGHER

 

Use Back of Form for Additional Family Members

 

Address (Street Address): _____________________________________________

                 (City, State, Zip): _______________________________________________________

 

Phone Number(s): ________________________________________________

E-mail Address (for news / information): __________________________________

Parent(s) / Guardian (for students under age 18): ___________________________

 

If person(s) named above is not available in the event of an emergency

Emergency Contact Name: ________________________________________

Emergency Contact Phone Number: ________________________________

Note: Students under the age of 8 should be accompanied in class by a parent, guardian or designated responsible adult.
 
 

 

 

 

 


Please list any medical / behavioral conditions: _______________________

________________________________________________________________

________________________________________________________________

 

I give my permission for full participation in the St. Francis of Assisi Martial Arts Program.

 

In case of emergency, I understand that every effort will be made to contact me (for an adult participant, spouse or next of kin will be contacted).  In the event I cannot be reached, I hereby give my permission to the licensed health-care provider, selected by the adult instructor or adult TSD administrator present, to secure proper treatment for my child (or for me, for an adult participant).

 

Date: _______   Signature of Parent / Guardian or Adult Participant ______________________
 
 

 

 

 

 

 

 

 


Forms may be returned to the SFA Rectory Office or sent to Jack Pereira. 

Please pay cash or check payable to SFA.

 

NOTE: CLASS SIZE LIMIT IS 25.   CLASSES FILL QUICKLY - PLEASE WATCH OUR WEBPAGE FOR ENROLLMENT STATUS (http://sfasports.net/martial_arts.htm).

 

SFATSD Use Only:

Date Received: _________________________   Processed by: ____________________

 

Payment Enclosed (cash) ________________     (or check #) ____________________

 
 
 

 



Class (check one)

6:15pm – 7:00pm (ages 5-7)* ______     7:00pm – 7:45pm (ages 8-11) ______       7:45pm-8:45pm (ages 12-Adult) _______

2nd Name (Last, First, Middle Initial): ____________________________________

Date of Birth: _____________       Gender (M/F): ____       Grade (Fall 08)*: _______

Please list any medical / behavioral conditions: ________________________

________________________________________________________________

________________________________________________________________

2nd Student Fee = $60 ($135 Total)

* MUST BE ENROLLED IN 1st GRADE OR HIGHER

 

Class (check one)

6:15pm – 7:00pm (ages 5-7)* ______     7:00pm – 7:45pm (ages 8-11) ______       7:45pm-8:45pm (ages 12-Adult) _______

3rd Name (Last, First, Middle Initial): ____________________________________

Date of Birth: _____________          Gender (M/F): ____     Grade (Fall 08)*: _______

Please list any medical / behavioral conditions: ________________________

________________________________________________________________

________________________________________________________________

3rd Student Fee = $45 ($180 Total)

* MUST BE ENROLLED IN 1st GRADE OR HIGHER

 

Class (check one)

6:15pm – 7:00pm (ages 5-7)* ______     7:00pm – 7:45pm (ages 8-11) ______       7:45pm-8:45pm (ages 12-Adult) _______

4th Name (Last, First, Middle Initial): ____________________________________

Date of Birth: _____________          Gender (M/F): ____     Grade (Fall 08)*: _______

Please list any medical / behavioral conditions: ________________________

________________________________________________________________

________________________________________________________________

4th Student Fee = $45 ($225 Total)

* MUST BE ENROLLED IN 1st GRADE OR HIGHER

 

Class (check one)

6:15pm – 7:00pm (ages 5-7)* ______     7:00pm – 7:45pm (ages 8-11) ______       7:45pm-8:45pm (ages 12-Adult) _______

5th Name (Last, First, Middle Initial): ____________________________________

Date of Birth: _____________          Gender (M/F): ____     Grade (Fall 08)*: _______

Please list any medical / behavioral conditions: ________________________

________________________________________________________________

________________________________________________________________

5th Student Fee = $45 ($270 Total)

* MUST BE ENROLLED IN 1st GRADE OR HIGHER

 

Class (check one)

6:15pm – 7:00pm (ages 5-7)* ______     7:00pm – 7:45pm (ages 8-11) ______       7:45pm-8:45pm (ages 12-Adult) _______

6th Name (Last, First, Middle Initial): ____________________________________

Date of Birth: _____________          Gender (M/F): ____     Grade (Fall 08)*: _______

Please list any medical / behavioral conditions: ________________________

________________________________________________________________

________________________________________________________________

6th Student = $45 ($315 Total)

* MUST BE ENROLLED IN 1st GRADE OR HIGHER