Ignite Karate Membership Form
Please fill out this form for all participants.  
Sign in to Google to save your progress. Learn more
Participant Name(s), DOBs, ages, and preferred pronouns.
Example: 
Peggy Punchalot, 1/1/14, age 9, they/them
Kareem Kicker, 1/1/18, age 5, he/him

*
Full Guardian Name(s), preferred pronouns, and Relationship to student *
Email Address: *
Phone Number: *
What is your mailing address? *
Is there anything you would like us to know or keep in mind about you/your child?  We strive to make classes accessible and fun for everyone, and will always take into account every person's unique circumstances.
I would like my email address to be added to the Ignite Karate monthly newsletter list (option to unsubscribe at any time) to see announcements about classes & special events, and get connected to the Ignite Capoeira community. *
Payment Agreement:   I understand that tuition payments are due on the first of each month.  
The first payment is completed when payment is remitted via the Stripe link sent via invoicing to the student's email- moving forward, payments are deducted automatically each month on the first of the month.

Students reserve the right to cancel their program at any time, although payments already made for classes are not refundable.  Notifications for cancellation/termination/program pauses must be emailed to info@ignitekarateacademy.com a minimum of 7 days before the first of the month.

The monthly tuition remains the same regardless of the number of classes a student attends per week.  We may close for major holidays, which will not affect the tuition rate.  If we have any class cancellations due to personal reasons by the instructor, we will offer a reduced rate for that month, or offer a credit.

By typing your full name below, you are virtually signing that you agree to and understand the Ignite Karate payment policy.
*
Please Virtually Sign our Online Training Waiver *
I hereby affirm that I am, or my child(ren) named above in this form are, voluntarily starting a class or course of instruction in physical fitness and karate with Ignite Karate Virtual Academy and Ignite Capoeira Virtual Academy, Jennifer Johnson-Blanchard, and James Lynch. I am/my children are voluntarily participating in capoeira entirely at my/their own risk. Classes will be provided in a live virtual format, for the enrolled to participate in from their own home. In full consideration of the risk of injury while participating in Ignite Karate Virtual Academy and Ignite Capoeira Virtual Academy classes, and for the right to participate in Ignite Karate Virtual Academy and Ignite Capoeira Virtual Academy classes, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily participate in this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation/my child(ren)'s participation in classes by Ignite Karate Virtual Academy, Ignite Capoeira Virtual Academy, Jennifer Johnson-Blanchard, James Lynch, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any kind of risks related to or participating from Ignite Karate Virtual Academy and Ignite Capoeira Virtual Academy classes, which may include, but are not limited to, physical or phycological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, economic or emotional loss, and death.
I acknowledge that I have carefully read this form and fully understand that it is a release of liability. I expressly agree to release and discharge Ignite Karate Virtual Academy and Ignite Capoeira Virtual Academy, Jennifer Johnson-Blanchard, and James Lynch from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action for personal injury or property damage.

By typing your full name below, you are virtually signing this release of liability, and agreeing that you are the legal guardian of any minors registered on this form.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report