Karate Child Enrollment
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1
2KARATE
Child Enrollment
Details
Name________________________________
Address ______________________________________________________
Home Phone____________________ Other Phone __________________
School_______________________________ Date of Birth_____________
Email_____________________________________
Parent / Guardian Details
Name/s_______________________________________________________
Address ______________________________________________________
Home Phone____________________ Work Phone __________________
Mobile Phone___________________ Email________________________
Emergency or Other Contact Numbers / Details
_____________________________________________________________
Medical Details
Any Chronic Illness or Injuries? (Past or Present)
___No
___Yes
(please specify)_____________________________________________________________
(Where possible please inform instructors of any treatment that might need to
be administered during a class)
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Parent category: Business