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Whitecourt Taekwondo Student Registration Form
Please Fill in All Sections of the Form as Applicable.
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* Indicates required question
Email
*
Your email
First Name (Student)
*
Your answer
Last Name
*
Your answer
Taekwondo Program Attending
*
Tiny Ninjas (Ages 3-4) Day Program ($225.00 for 3 months)
Little Dragons (Ages 5-7) Program ($225.00 for 3 months)
Beginner and Color Belt (Ages 8+) Program ($300.00 for 3 months)
Black Belt (All Ages) Program ($150.00 for 3 months)
Home School Program (In Person) ($300.00 for 3 months)
Home School Program (Online) ($300.00 for 3 months)
Adult Only Class (Ages 14+) ($300.00 for 3 months)
Required
Guardian Name 1
*
Your answer
Guardian Phone 1
*
Your answer
Gender
*
Female
Male
Prefer not to say
Medical Concerns
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Emergency Contact
*
Your answer
Emergency Phone (XXX-XXX-XXXX)
*
Your answer
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