Children's Aikido Application

Applications available at the dojo, or you can print , fill out, and bring to class the application below

Classes At the Orchard

Student Name ______________________________________              Age _____ 

School ____________________________________________             Grade _____

Parents/Guardians ___________________________________________________

Address       _______________________________________________________


Mailing address (if different) ___________________________________________

___  I would like to receive announcements by email

Email address ______________________________________________

Phone #’s:     Home: ______________________         Cell:  ____________________
                        Work:  _____________________       Other: ____________________

Please note that my child  _______________________________________________


Medical : medication, health concerns, injuries _______________________________

Alternative .Emergency Contact __________________________________________ 

Phone # ____________________     Relationship __________________________       

How did you hear about the Aikido program? 



I understand that martial arts training, which includes throws, falls, contact sparring and weapons training, has inherent risks and I hereby indemnify, hold harmless, release and forever discharge Avella Orchard, Classes at the Orchard, its instructors and students, and the owner(s) of the property, from any and all claims and demands whatsoever which I, my heirs, representatives, executors, administrators or assigns have or may have against these parties by reason of any accident, injury, death or other consequences arising or resulting directly or indirectly from my participation in classes or other activities conducted under the auspices of Avella Orchard, and occurring during my participation or any time subsequent thereto.

I have read and agree to follow the program guidelines and understand that failure to comply with them may result in immediate withdrawal from the program.

Student (if over 12) Signature _____________________________________________  

Date ___________

Parent/Guardian Signature _______________________________________________     
Date  ___________