WSA Adult and Teens Membership Form

WSA Membership Form for Teens & Adults (13+)

Complete the form below to sign up for membership for teens and adults
Applicant Information:
Name *

First Name Last Name
Birth Date: *

Month Day Year

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *

Area Code Phone Number
Emergency Contact *
Emergency Contact Phone Number *

Area Code Phone Number
Relation *
Where did you hear about us?

A Friend or colleauge Google News Article Valpak
Tuition *

Monthly Tuition $ 125.00

Quarterly Tuition $ 330.00

6 Months Tuition $ 600.00

One Year Tuition (Best Value) $ 1,080.00

Total $ 0.00
Parent or Guardian Safety Affirmation and Release
*

I have read, understood, and accepted the rules for Parent or Guardian Safety Affirmation and Release
I, hereby certify I am cognizant of all the risks and dangers of practicing, studying, or demonstrating the martial arts. I understand that it is not the purpose of this course to teach safety rules, nor is it the function of the instructors to serve as the guardians of my safety. In considering the acceptance of my entry into this club, I hereby now and forever, fully release and discharge and agree to save, indemnify and keep harmless the WASHINGTON SHITO RYU ACADEMY, their officers, agents, employees, instructors, members and authorized guests from all liability, claims, judgments or demands for damages arising from damages to me or my property occasioned by the acts of negligence, or failure of act of the WASHINGTON SHITO RYU ACADEMY, their officers, agents, employees, instructors, members, and authorized guests, and I further agree I will never institute any suit or action at law, or otherwise, against the WASHINGTON SHITO RYU ACADEMY, their officers, employees, agents, instructors, members, and authorized guests on account of or arising out of damage, loss or injury to me. I further state that I am of legal age and legally competent to sign this release. I understand that the terms herein are legally binding and not a mere recital and that I sign this document as my own free act.

I HAVE FULLY INFORMED MYSELF OF THE TERMS AND CONDITIONS OF THIS AFFIRMATION AND RELEASE BY READING IT BEFORE I SIGNED IT. I have had a full medical examination to assure myself, and assume my own responsibility of physical fitness to engage in practice, study, or demonstration of above mentioned subjects, and am physically fit as attested by the aforementioned medical examination, and I agree to maintain at all times a policy of medical and accidental insurance.

Tuition Refund Policy:
*Washington Shito Ryu Academy has a standard no refund policy
*Tuition is not prorated for missed classes
*If a student is unable to attend classes, they have the option to transfer unused credit to an immediate family member (parent or sibling)
Welcome to Washington Shito Ryu Academy. Your training classes begins today.
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WSA Membership Form for Teens & Adults (13+)

Parent or Guardian Safety Affirmation and Release