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:
*REGISTERING FOR WHICH CLASS?

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)
Do you have any Physical Limitations, Special Needs, or Medical Conditions which we need to be made aware of for your safety? Y/N (Explain)
Signature