Poway Unified School District Winter 2018 (Jan., Feb., March)
After School Enrichment Registration Form for Karate

To register your child, please complete all parts of this registration form and click on the "Register Now" button. You will then be provided with payment options for the registration and uniform fees.

1. Student information:

First Name:* Last Name:*

Birthdate:*       Gender: Male Female

PUSD Elementary School:* Grade:*

2. Uniform information:

Height:     Weight:     Clothing size:

3. I am registering for/purchasing (select one):

Session 1 Only ($120 per Session)   *Session plus FREE Uniform ($120)
(*Free Uniform is available when Registering for your First TEMAS Karate Session ONLY.)
All three (3) Sessions plus FREE Uniform ($360), this option available at start of school year.

Does your child have an approved uniform?* Yes No

Payment will be made by:*
Credit Card or Paypal (online) Credit Card (call in) Check (mail in)

4. Parent contact information:

Parent's Name:*

Parent's Phone Number:*
(ex. 123456789)

Email address:*
(ex. jsmith@mail.com)

Mailing address:*

5. Additional information about your child:

Where will your child go after class?*

My child will attend ESS
My child will be picked up by
My child will walk home

My child has outdoor allergies (please provide details):

Terms and Conditions:

Please read this important statement before submitting this form:

By submitting this Registration Form, I indicate that I have read and agree by participating in Martial Arts that my child may risk bodily injury and knowingly and freely assume all risk for my child. I release and hold harmless and nor hold legally responsible the PUSD, TEMAS or MANNA'S with respect to any injury except that which results from negligence or willful misconduct. I have made my child aware of the safety rules of the school and give my permission for him/her to particpate in this Enrichment Program.

Do you agree to the Terms and Conditions? Yes