Guest Information

Parents First Name

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* 1. Parents First Name

Parents Last Name

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* 2. Parents Last Name

Parents Cell Phone Number

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* 3. Parents Cell Phone Number

Participants First and Last Name

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* 4. Participants First and Last Name

Email Address

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* 5. Email Address

Emergency Contact Phone Number

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* 6. Emergency Contact Phone Number

I certify that I am physically fit to receive instruction and participate in this program and I understand and agree that Kicks Karate, or its owners, will not be held liable for any injuries, damages, etc. not caused by or resulting from the negligence of the owners, operators, or persons in charge of such establishment, and likewise assume full responsibility for all my actions in connection with the martial arts program. I give permission to Kicks Karate and its affiliates to use the above email address for marketing, transactional, and relational content until which time I opt-out of such email correspondences. By clicking the I AGREE button and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.
Whose Birthday Party Will Your Child Be Attending? (First & Last Name)

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* 7. Whose Birthday Party Will Your Child Be Attending? (First & Last Name)

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