GARCIA BOXING

Enrollment & Waiver – For Boxing

Please complete the intake and waiver form accurately and completely — it is required for enrollment. Do not skip any questions.

If you have any concerns or questions, please call or text us at 760-815-1254.

Monthly Tuition: $49 Class Schedule: Every Monday at 5:45 PM

Location 1234 N Santa Fe Ave Vista, CA 92083

Questions or to Schedule Private Lessons? Coach Franklin: 760-783-6325 Coach Javier: 760-682-5262

We’re excited to have your child join us on the mat! 🥋

Inscripción y Exención de Responsabilidad – Boxing

Por favor complete el formulario de inscripción y exención de responsabilidad de manera exacta y completa, ya que será utilizado para la inscripción oficial. No omita ninguna pregunta.

Si tiene dudas o preguntas, puede llamarnos o enviarnos un mensaje en cualquier momento al: 760-815-1254

Costo mensual: $49 Clase: Todos los lunes a las 5:45 PM

Ubicación 1234 N Santa Fe Ave Vista, CA 92083

¿Preguntas o para agendar clases privadas? Coach Franklin: 760-783-6325 Coach Javier: 760-682-5262

¡Estamos emocionados de recibir a su hijo/a en el tatami! 🥋

Date required

NAME (FIRST AND LAST) A - Boxing

Age of A

NAME (FIRST AND LAST) B -Boxing

Age of B

NAME (FIRST AND LAST) C - Boxing

Age of

PARENTS (FIRST AND LAST NAME)

Cell Phone

ANY DISSABILITIES OR MESSAGES FOR SENSEI SAL

Street Address

City

Region/State/Province

Postal / Zip code

I accept terms & conditions (Hold Harmless Agreement I, the undersigned parent/guardian having legal custody/guardianship of the above said minor(s), give permission for the minor(s) to participate in all Cirincione’s Inc./Karate Kids in America/Shorinkan San Diego club programs and any other affiliations. The Minor/Adult is physically able and mentally prepared to participate in all activities as described in the announcement for the program. In consideration of said Minor/Adult being permitted in any Cirincione's Inc./Karate Kids in America/Shorinkan San Diego activity for observation, use of facilities and/or equipment, or participation of the above in any program. I, on behalf of myself (as parent, guardian, coach, aide, spectator, or participant) hereby acknowledge that :(i) I have read this document, (ii) I have inspected the facilities and equipment, (iii) I accept them as being safe and reasonably suited for the purpose intended and (iv) I voluntarily sign this document. I release Cirincione’s Inc./Karate Kids in America/Shorinkan San Diego and/or its directors, officers, employees, volunteers and any affiliates (collectively “Cirincione's Inc.”) from all liability to me for any loss or damage to property, inju ry, or death to person, whether caused by Cirincione's Inc. or otherwise and while such minor/adult is in or near any Cirincione’s Inc./Karate Kids in America/Shorinkan San Diego activity or branch. I agree not to sue Cirincione’s Inc. for any loss, damage, injury, or death described above and I will indemnify and hold harmless Cirincione’s Inc. and each affiliate from any loss, liability, damage or cost they may incur due to said minor’s/adult presence in, upon or near any Cirincione’s Inc./Karate Kids in America/Shorinkan San Diego clubs activity or branch; whether caused by the negligence of Cirincione’s Inc. or otherwise. I assume full responsibility for and risk of, bodily injury, death or property damage due to the negligence of Cirincione’s Inc. or otherwise. I do hereby authorize Cirincione's Inc./Karate Kids in America/Shorinkan San Diego clubs as agent for the undersigned, to consent with respect to said minor, to any x-ray examination, anesthetic, medical, dental, surgical procedure, unspecified medical treatment, and/or hospital care which is deemed advisable. The medical care is to be rendered under general or special supervision of, any physician and/or surgeon licensed under the provisions of the California Medical Practice Act. I understand that Cirincione’s Inc./Karate Kids in America/Shorinkan San Diego club programs and any other affiliate is not responsible for cost incurred for medical, surgical or dental care. I intend this document to be as broad and inclusive as is permitted by the laws of the State of California: if any portion hereof is held invalid, I agree the Release Form shall continue in full force and remain effective)

Cell Phone