Boy's And Girl's Club Enrollment

FREE PROGRAM

Date picker

First Name Participant#1

Last Name Participant #1

Age Participant #1

First Name Participant #2

Last Name Participant #2

Age Participant #2

First Name Participant #3

Last Name Participant #3

Age Participant #3

First Name Participant #4

Last Name Participant #4

Age Participant #4

First Name Parent #1

Last Name Parent #1

Cell # Parent #1

First Name #2

Last Name Parent #2

Cell # Parents #2

Address

City

Sip / Postal code

Hold Harmless Agreement. I, the undersigned parent or legal guardian of the minor(s) named above, hereby give permission for the minor(s) to participate in all programs, activities, classes, and events operated by Cirincione’s Inc., Karate Kids in America, Shorinkan San Diego, and their affiliates (collectively “Cirincione’s Inc.”).

I confirm that the minor(s) and/or adult participant is physically able and mentally prepared to participate in the announced activities. In consideration of being permitted to observe, use the facilities and equipment, or participate in any Cirincione’s Inc. program, I acknowledge on behalf of myself and the minor(s) that:

I have read and understand this document;
I have inspected the facilities and equipment and accept them as safe and suitable for their intended purpose;
I voluntarily agree to all terms.

I hereby release, discharge, and hold harmless Cirincione’s Inc., its directors, officers, employees, volunteers, instructors, and affiliates from any and all liability for any loss, damage to property, injury, or death that may occur to the minor(s) or myself, whether caused by negligence or otherwise.

I agree not to sue Cirincione’s Inc. for any such claims and will indemnify and hold it harmless from any loss, liability, damage, or cost it may incur due to the minor’s or my presence or participation, including claims arising from negligence.

I assume full responsibility and all risks of bodily injury, death, or property damage related to these activities.Medical Authorization

I authorize Cirincione’s Inc. to act as my agent and consent, on behalf of the minor, to any x-ray examination, anesthetic, medical, dental, surgical procedure, or hospital care deemed advisable by a licensed physician or surgeon under the California Medical Practice Act.

I understand that Cirincione’s Inc. is not responsible for any costs incurred for medical, surgical, or dental care. I intend this agreement to be as broad and inclusive as permitted by California law. If any portion is held invalid, the remainder shall continue in full force and effect.

Signature

Modo de dibujo seleccionado. Para dibujar, necesitas un mouse o un panel táctil. Usa la función de accesibilidad del teclado al seleccionar Escribir o Subir.

Boys & Girls Club Karate Program – Intake & Waiver Required

Please complete the attached intake and waiver form accurately and completely, as it is required for enrollment in the Boys & Girls Club Karate Program. Do not skip any questions. If you have any concerns or questions, please contact us at 760-815-1254.

Open to all Boys & Girls Club members When: Every Wednesday at 5:00 PM Where: Boys & Girls Club of Vista 410 W California Ave, Vista, CA 92083

We look forward to seeing your child on the mat!

Program Details

This is a FREE program taught by internationally certified instructors.
All students will progress through the traditional colored belt system.
A karate uniform (gi) is NOT mandatory, however it greatly increases motivation and a sense of achievement. Uniforms are available for purchase for $45. → To order a uniform, please call or text 760-815-1254. Go to this address, Purchase Location: 1234 N Santa Fe Ave Vista, CA 92083. Its near the Club