American Tiger Karate Academy




* Required Information

Please Read Waiver of Liability Web Page Before Filling Out Online Registration Form.
*Students Last Name
*First Name
*Middle Initial
*Street Address
*City
*State
*Zip Code
*Home Phone
*E-Mail Address
*Gender
*Students DOB

Only applies if student is under the age of 18
Parents Full Name, Last, First, MI
Referred By:
*Name of class for which you are registering

ARE YOU USING A COUPON TODAY?
Coupon Description

Waiver of Liability Section

Located Below the Registration Tab Waiver of Libility Section
*I have read and understand the Waiver of Liability Section (Print Name, & Date)
SKIF Dojo Name:
Current SKIF MBR: Y/N
SKIF Sensei Name:
Gasshuku Fri 5/17 6:30p Y/N
Gasshuku Fri 5/17 7:45p Y/N
Gasshuku Sat 5/18 8a Y/N
Gasshuku Sat 11:30a Y/N
Gasshuku Sat 5/18 2p Y/N
Gasshuku Sat 5/18 4p Y/N
SKIF Dinner Sat 5/18 7p Y/N
Gasshuku Sun 5/19 9a Y/N