Please complete the registration form below to join Curry's Martial Arts Academy. We're excited to welcome you to our community of dedicated martial artists. This form helps us understand your goals and tailor our programs to meet your needs.

Curry’s Martial Arts Academy

Martial Arts Registration Form Empowerment • Discipline • Legacy

  Student Information

• Full Name: __________________________________________

• Date of Birth: ____ / ____ / ______

• Age: ______

• Gender: ☐ Male ☐ Female ☐ Other

• School (if applicable): __________________________________________

• Grade Level: ______

   Contact Information

• Parent/Guardian Name (if under 18): __________________________________________

• Phone Number: (_____) _____ - ______

• Email Address: __________________________________________

• Home Address:

  City: ___________________ State: ______ Zip: __________

🥷 Program Selection

☐ Lil Warriors (Ages 4–7) ☐ Lady Warriors (Self Defense Program) ☐ Youth Martial Arts (Ages 8–17) ☐ Adult Martial Arts (18+) ☐ Private Lessons ☐ San Koken-Do Certification Track

 Preferred Class Schedule

☐ Weekday Evenings ☐ Saturday Mornings ☐ Flexible / To Be Scheduled

   Emergency & Medical Info

• Emergency Contact Name: __________________________________________

• Relationship: ___________________

• Phone Number: (_____) _____ - ______

• Known Allergies or Medical Conditions:

• Physician Name & Contact (optional):

   Media Release

☐ I grant permission for Curry’s Martial Arts Academy to use photos/videos of the student for promotional purposes. ☐ I do NOT grant permission.

    Liability Waiver & Signature

I understand that martial arts training involves physical activity and assume all risks associated. I release Curry’s Martial Arts Academy and its instructors from liability for any injuries sustained during training.

Signature (Parent/Guardian if under 18): ___________________________ Date: ____ / ____ / ______