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The DOJO Enrollement Form

First Name

Middle Initial

Last Name

Date of Birth (click in date field, the click on month at top of popup, then click year, then select year, then month, then date.)

Address

City

State

Zip

Additional Students

Additional Student #1

First Name

Middle Initial

Last Name

Date of Birth (click in date field, the click on month at top of popup, then click year, then select year, then month, then date.)

Additional Student #2

First Name

Middle Initial

Last Name

Date of Birth (click in date field, the click on month at top of popup, then click year, then select year, then month, then date.)

Additional Student #3

First Name

Middle Initial

Last Name

Date of Birth (click in date field, the click on month at top of popup, then click year, then select year, then month, then date.)

If Minor (>18) Responsible Party

Phone Number for reminder messages

(If you do not receive messages Text ext @dojost to the number 81010)

Emergency Contact

Emergency Contact Phone Number

Emergency Contact Email Address

Parent Code

Student / Parent

Date

Free Trial – 2 Class 3 Class (no Uniform) - $29.95 2 Weeks + Uniform $39.95

Please review waiver.
I knowingly understand that the practice of Tae Kwon Do can potentially be dangerous and do by signing this release,
release the DOJO and Hot Shot Tees its staff, its owner(s), and any person or organization connected from any and
all claims, demands, damages, costs, expenses, actions and causes of action for all personal injury, including latent
back or leg injuries, bruises, sprains, dislocations, possible broken bones, possible latent or occurring internal
injuries, or damage to the brain, eyesight, for all disability, property damage, loss or damages of any kind sustained
or that may here or after be sustained either in class, out of class, traveling to or from class, related activities, or
otherwise. I likewise assume full responsibility for all my actions in connection the DOJO.
Non-compete/Solicitation Covenant. For a period of 2 years after the effective date of this Agreement, student will
not directly or indirectly engage in any business that competes with the Dojo. Or directly or indirectly solicit a business
from, or attempt to sell similar products to any customer or client of the Dojo after the effective date of this agreement.

I have reviewed and agree with waiver