Alternative Sign Up Form Sign Up Form Register Students Number of Adults (18+) 1 2 Name of Adult(s) * Number of Teens (13-17) 1 2 3 Name and Age of Teen(s) * Number of Jr Ninjas (9-12) 1 2 3 Name and Age of Jr Ninja(s) * Number of Mini Monks (6-8} 1 2 3 Name and Age of Mini Monk(s) * Number of Tiny Tigers (4-5) 1 2 3 Name and Age of Tiny Tiger(s) * Previous Martial Arts Training? Describe here: * Fees (discounts applied) 1 Adult, Teen or Jr Ninja Full Price $418.00 1 Adult, Teen or Jr Ninja at 25% off $418.00 Subtotal for additional Adults, Teens or Jr Ninjas at 50% off $418.00 1 Mini Monk or Tiny Tiger at full price $398.00 1 Mini Monk or Tiny Tiger at 25% off $398.00 Subtotal for additional Mini Monks or Tiny Tigers at 50% off $398.00 Total Charge Parent/Guardian/Adult Contact Name * Phone * Email * Waiver of Liability The student (and parent/guardian) assumes all risk inherent and incidental to the martial arts as a condition for applying for admission to this self defense training facility. Boulder Karate and its representatives are not responsible for any injury suffered while on the premises. We reserve the right to take videos and pictures of classes and events and use them for promotion. We reserve the right to dismiss any student for misconduct or violations of dojo etiquette. Agree to Waiver Conditions * By checking this box I confirm I am 18 years old or over or I am the legal guardian of the child registered and I agree to the terms of the waiver. Signature Clear Boulder Karate Information & Newsletter Sign me up Fees Calculation GRAND TOTAL Cardholder Name * First Name Cardholder Last Name * Last Name Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Email * Credit Card * Submit
