Try Taekwondo at our Moncton Location, Start Your Journey with Anika TKD

First name

Last name

Address

Email

Phone

Have you ever studied Martial Arts before?

If Yes, When?

Have you ever studied Taekwondo before?

If Yes, with who?

If you have prior training in any Martial Art what Belt and/or Rank are you?

Birthday

Year

Month

Day

Parents or Spouses Name/s

Do you have a Family Dr.

Yes

No

Name of Family Dr. (This form goes with the 911 First Responders in case of a serious injury.

Medicare #

Do you have any allergies

yes

No

What Allergies? If any

Any Dr. Rx Medications a first responder needs to be aware of?

Yes

No

If so please list.

Multi choice

I am over 18

Signed Parent Liability Waiver

Signature

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Please sign clearly

Date and Time of Registration Todays Date

Year

Month

Day

Time

HoursMinutes

Up Load Copies of your Waivers

Donation

$10

$20

$30

Checking Yes Here, says you read signed Liability waivers either on paper in person or submitted them online via our Files Upload service on the registration form.

We can be reached via E-Mail at askanika@anikatkd.ca

We can be reached by Phone at 1 (506) 871-4384

Try Taekwondo at our Moncton Location, Start Your Journey with Anika TKD

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