America's Best Karate of Los Gatos - Graystone Home & School Club

America’s Best KarateRegistration and Information FormPlease PrintChild’s NameParent’s NameAddressHome Phone or Cell Email Address DOB/Age/SexClass Time Preference___Monday ____Tuesday ___ Wednesday___Thursday ____ Friday ___ SaturdayProgram(Check One): _____ Dinosaur _____ Pee Wee ____ Juniors_______ Adult _____ Bollywood _____ Pilates ____ YogaMedical Conditions or special circumstances that we should beaware of:Donation: Any amount is acceptable.Suggested Donation$90 (For 2 day per week)$60 (For 1 day per week) $30 per each additional dayChecks should be made payable to Graystone Home and School ClubWaiver:I hereby waive and release America’s Best Karate and its staff members from anyand all liability for any injuries or illness incurred to my child during karate class.The undersigned in consideration of participating in this program agrees toindemnify and hold the Graystone Elementary School, Graystone H&S Club, staff,parent volunteers, and the program instructors harmless and release them from anyand all liability for any injury which may be sustained by the named individual(s)registered in this program. I have read the application agreement, and fullyunderstand that I assume all risks for any injuries received.Parent’s Signature ________________________ Date:_____________