Afterschool Leadership Academy
To enroll in our After School Leadership Academy, please complete the application and submit it to our office with 1st-month tuition payment. Upon receipt of your application and payment, you will receive a confirmation email along with a copy of the agreement terms.
Email *
Name of Student(Last, Middle, First) *
Age of Student/ Grade *
Date of Birth of Student (Month/ Day/ Year)
Name of Parent#1 (Last, Middle, First) *
Name of Parent#2 (Last, Middle, First)
Cell Parent#2 (Last, Middle, First)  
Home Address/ City / Zip/ *
Cell Phone/ Home Phone *
Emergency Contact *
Which School will we be picking up your Child? *
Which days will your child be attending After-School? *
Required
Two Dragons Martial Arts Studio General Rules
• No students are allowed on mat space without permission• Bottles, cans, paper, and trash must be disposed of in the appropriate receptacles provided.• All equipment must be properly put back in its place after use.• Properly cleaned Gi and equipment are required for class participation.• Members must have respect for the trainers, instructors, and other members. Membership may be revoked for disrespectful behavior.• For Health safety no outside shoes on the mat.• All hands must be sanitized to use any shared equipment, refrigerator, restrooms, and etc.• Parents are not allowed to communicate or distract their child without permission from instructor, coach, or Two Dragons Staff.• No posting of personal advertising or other literature is allowed without the permission of management.• Adjustments to the television, stereo, heater, fans or other equipment may be made by a staff member only.• If a younger sibling is waiting please ensure their safety behind the safety line of the mat during a class. *
Parental Consent
I, the undersigned, do hereby voluntarily submit my application for attendance and participation in the TWO DRAGONS MARTIAL ARTS COURSE and do hereby assume full responsibility for any and all damages, injuries  or losses that I may sustain or incur, if any, while attending or participating, and I hereby waive all claims against the promoters, owners, or operators of TWO DRAGONS MARTIAL ARTS, Shelene Hearring and staff individually or otherwise, for any claim for injuries that I may sustain. I also understand that if I have any physical problems that it is my responsibility to check with my doctor before taking this program.  I fully understand that any medical treatment given me will be of first aid treatment type only. *
____________________________________________________________ Parent name/                           Signature               /                Date          
TDMA office will print out this form for you to sign in person at office.
Tuition Information and Polices
*Balance of tuition is due in full by 1st day of Enrollment.  *If the balance is not paid by this date, you will lose your reserved space and your monthly payment.
*If you enroll after August 1,  the full amount of tuition is due with your application.
*If you withdraw before August 1, Or 1st Day of the Start date, tuition will be refunded in full, less a $200 cancellation fee.
*As of September 1,  (or 1st day of school), no tuition will be credited or refunded. This includes days/weeks missed due to illness, school schedule, activities, and personal/ school vacations.
*As of September 1,  (or 1st day of school), days of enrollment cannot be exchanged without prior written notice. Additional days can be added at any time and payment is required before your child can attend.
*All Tuition is paid in full monthly and billed on the 1st of every month. A $30 late fee will be assessed for payments received after the 5th of the month.
*For early termination, a written notice must be received  30 days in advance to remove a child from the program.  
*If we do not have space for your child, tuition will be fully refunded, with no cancellation fee.
*Tuition includes transportation from school and healthy snacks daily.
*Overtime pick up for students later than 6 pm are Strongly Discouraged. A $15.00 per child for every 15 minutes of delay will be billed to your account. (Rev. Revised 2/13/18)

TDMA office will print out this form for you to sign in person at the office.

__________________________________________________________________________________________
Student printed name (or parent)                   Signature                                                        Date

Two Dragons Martial Arts2490 North Lake Ave  Altadena, CA 91001    626.398.8853   www.TwoDragonsMA.com
For Office Use Only
Interviewer: _________________________ Gi received Y/N Student id#__________ File date______
Application complete Y/N    Waiver Y/N Gi Size ______ Student competed___ Filed by_____
Student (and/or parent) Orientation Date:_____ Belt size_____ Billing type_______1st /15th/25th Cust. Type______
Enrollment Term_______ / Renewal_______ Program_______ Program Amount___________ Paid_________
Revised 2/21/19
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