Woo Kim Nanaimo Taekwondo School
Traditional Korean Martial Art & Olympic Sport
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Online Student Registration
Online Student Registration
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Step
1
of 4
Applicant's Name
*
First
Middle
Last
Have you trained in martial arts before?
Yes
No
Belt rank at your former school and school name
Next
Personal Information
Email
*
Age
Birth Date
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Male / Female
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Female
Address
*
City / Town
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Postal Code
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Home Phone
*
Cell / Work Phone
*
Next
Emergenc;y Contact / Medical
Emergency Contact
*
Emergency Contact Phone
*
Care Card Number
*
Doctor's Name
*
Alergies, medication, special medical conditions or enter "none"
Please describe any alergies, medication, or special medical conditions you think we should know about.
Next
Section Divider
Waiver Agreement / Application Date
Waiver
*
I agree with the RELEASE OF LIABILITY AND WAIVER OF CLAIMS outlined below.
Any additional comments?
Parent/Guardian Name (If student is under 18)
Date
*
Phone
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