Home

Skip to Payment Form

Registration form

* Indicates required field

Student Name *

First

Last

Date of Birth *

School (select one) *

Age *

Date of First Class *

Parent/Gaurdian Name *

First

Last

Home Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Cell Phone *

Do you give permission for your child to be photographed by AAISDA for marketing purposes? *

Yes No

1) This registration form must be completed in full and turned in to school or instructor with a full month’s payment before your child can participate.
2) If there is any information about your child that we should be aware of, please attach note for instructor.
3) I understand that monthly tuition is due by the first of the month and that payments received after the fifth of the month will be assessed a $10.00 late fee. A $20.00 fee will be charged for returned checks. No refunds will be given for an absence on behalf of the student. Tuition and lessons are based on four classes per month. If a month would result in five classes there will be no class on the fifth week unless scheduled differently.
4) If you should decide to withdraw your child from the program, notify your school director or karate instructor in writing two weeks before the first of the month in which you wish to withdraw to avoid being billed for that month.
5) I understand that with any program such as this, some risks are involved even though precautions are taken to prevent accidents. Therefore, I, my heirs, and
the student being registered, do hereby release AAISDA, INC. and any of its instructors or guests, as well as the facility where classes are held, from all claims or injuries and/or damages in connection with this class.

Signature of parent/legal gaurdian *

Date *

Typing your name above the signer agrees it is valid and equal to signing by hand

Submit

Already registered? Proceed to payment info below

Payment Info

Arizona American Institute
for Self Defense Arts, inc

Registration form

Upcoming Events Newsletter

Arizona American Institute​for Self Defense Arts, inc

Registration form

Upcoming Events Newsletter

Arizona American Institute
for Self Defense Arts, inc