After School Registration

Parent / Guardian Information

Please provide at least one parent's name and phone number.

Father

Father's Name Father's Phone Father's Email

Mother

Mother's Name Mother's Phone Mother's Email Address

Child Information

Student Name * Student's Birthday Grade School

Pickup

Requested Start Date

Medication

Does the student take medication or have allergies? *

Yes No

If YES, please describe (medication, dosage, allergy details)

Waiver & Consent *

I acknowledge that participation in the After School Program at Golden Eagle Taekwondo may involve a risk of injury. I certify that I have disclosed to Golden Eagle Taekwondo any medical conditions, restrictions, or allergies that may affect my child's participation, and that my child is physically and mentally fit to participate.

I release and forever hold harmless Golden Eagle Taekwondo and its owners, instructors, staff, volunteers, and representatives from any and all liability, claims, demands, or causes of action arising out of any injury or illness my child may suffer as a result of participation in any class, program, activity, or event, including transportation to and from such activities.

I authorize Golden Eagle Taekwondo to use photographs and video taken of me and/or my child during participation in its programs for promotional and marketing purposes, including on its website and social media, without compensation. I understand these photos/videos remain the property of Golden Eagle Taekwondo.

I have read, understand, and agree to follow the studio's rules, code of conduct, and policies, and I understand that failure to do so may result in suspension or dismissal from the program.

I agree to this waiver

Payment Authorization

Please check one of the following: Registration $50 ( New Member Only )

CMS SCHOOLS: August $130, September ~ May $390, , December $330, June $190

LAKE NORMAN: August $290, September ~ November $390, December $330, Jan ~ May $390

BONNIE CONE: August ~ November $390, December $330, Jan ~ May $390

PROMISSORY NOTE, CUSTOMER ASSIGNMENT, AND EFT AUTHORIZATION

I understand that this authorization will remain in effect until revoked in writing and I agree to notify MASTER KANG'S GOLDEN EAGLE TAEKWONDO (GETKD). If the payment date above falls on a weekend or public holiday, I understand that payment may be made on the next business day. I understand that because this is an electronic transaction, funds may be withdrawn from my account as soon as the regular transaction date specified above. If your transaction is declined due to insufficient funds, you may retry processing the claim within 30 days at GETKD's discretion and agree to charge an additional fee of $35 for each retry. I acknowledge that all transactions on my account must comply with the provisions of United States law. I certify that I am an authorized user of this credit card and will not dispute any planned transaction with my credit card company as long as the transaction matches the terms shown on this authorization form. We will charge every first day of the month. Since expenses continue whether or not your child is present, there are no deductions in weekly tuition fees for absences. Parents must notify the school if their child did not go to their academic school or was picked up early. In inclement weather, we will do our best to be open. The only reason we would not be is if the roads were unsafe.

PURCHASER SIGNATURE

x (Please sign in the signature section below.)