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Maine Traditional Karate: Registration
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Student Full Name
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Student Birth Date
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DD
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Student Class Group
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Select the best class group based on age
ORRINGTON: Adult (13+ yrs of age, MON/WED 6:45-8:00PM & FRI 7:00-8:00PM)
ORRINGTON: Youth (8+ yrs of age, MON/WED 5:30-6:30PM & FRI 7:00-8:00PM)
ORRINGTON: FRIDAY Little Samurai (4-7 yrs of age, 6:00-6:45PM)
CORINNA: Combined Class (All ages, THURS 5:30PM-6:30PM)
ORRINGTON: Rec Program (4-7 yrs of age)
Email Address
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Phone Number
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Mailing Address
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Please write out as follows: Mailing Address, City, State, Zip
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Sign Up For Location
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Orrington
Corinna
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Emergency Contact Name
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Emergency Contact Phone Number
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Medical Conditions
If there are any medical conditions that may impact your ability to participate in a physically active impact sport, please note them here. This is to help inform instructors in order to keep the student safe.
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Additional Comments/Information
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Discount Program
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*For all classes EXCEPT Orrington Recreation Program* If you qualify for one of the following programs please select it. We may ask for verification of your qualifying status.
None
Military Discount (Active Duty, Retiree, Veteran)
First Responder (Police, Firefighter, EMT)
Northern Lights Employee
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