Registration Form

Participant Information   *required
First Name*
Last Name*
Address*
City*
State*
  Zip Code*
Home Phone*
E-mail*
Date of Birth*
 
Gender*
Rank*
Dan— Degree  
Your Taekwondo School Information   *required
School Name*
School Address
School City
School State
 Zip Code
Instructor’s Name
School Phone
School E-mail
LIABILITY WAIVER (Check in agreement with Liability Waiver)
In consideration of your acceptance of my entry, I do hereby for myself, my heirs, executors and administrators waive, release and forever discharge any and all rights and claims for damages which I may have or may accrue to me against CT Chung Do Kwan, LLC and all members of the camp or their respective officers, agents, representatives, successors, and/or assigns and against any participant for any and all damages which may be sustained by me in connection with my association with, or entry, in the above athletic camp, or which may arise out of traveling to, participating in, and returning from such athletic camp. I understand that Taekwondo is a body contact sport, and I further understand all the contents, rules and general information by which the camp operates.
Total Amount Due $
160
Payment Information (Secure Transaction)   *all fields required
VISA and MasterCard accepted
Credit Card Number*
Expiration Date (mm/dd)*
First Name*
Last Name*
Address*
City*
State*
Billing Email Address*
 
  Check the box above to enable the Submit button.
 
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