Hetlinger TaeKwon-Do Wetaskiwin Digital Registration Form

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Email *

Student Information

Please fill out the following information for the student that will be training.

First and Middle Name: *

Last Name: *

Mailing Address (Street Number, Street, City, Province, Postal Code) *

Home Phone Number: *

Work Phone Number:

Age: *

Date of Birth: *

YYYY

Medical/Physical Information and/or consideration Pertinent to Training (if none, please put "n/a") *

Emergency Contact Name (other than parent if student is under 18) *

Emergency Contact Phone Number: *

Rank *

Buyer/Parent Information

Fill out the following questions if the student is a minor, or not the person paying registration/monthly fees.

Parent/Guardian Name:

Relationship to Student

Father

Mother

Guardian

Other:

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