RELEASE/DISCLOSURE AGREEMENT  


ENROLLING IN VICTORY KARATE/VKfit WITH ERIK AKUTAGAWA:


Signed: _______________________________ Date:_____________

Name (printed): _______________________________


Parent/Guardian signature if under 18: ________________________

Parent/Guardian name (printed): _____________________________















Personal Information:

Name: _____________________________________________________

Address: ___________________________________________________

City: __________________________________   Zip: ________________

Phone: _____________________________

Secondary phone: _____________________________

Email address: _______________________________

Birthdate: __________________



Emergency contact information:

Name: _____________________________________________________

Phone: _____________________________

Secondary phone: _____________________________



Other information:

Occupation: _________________________________________________

Prior training: ________________________________________________

Other interests: _______________________________________________


How did you find out about Victory Karate/VKfit?

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Why are you interested in training with Victory Karate/VKfit? What do you want to accomplish through your training with Victory Karate/VKfit?

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