Build Your Future

PARTICIPANT INFORMATION:

Last Name: _______________________________________________ First Name: ______________________________________________

Gender (Male / Female): __________________________

Date of Birth (DOB): _________________________________________________ Age: ___________________________________________

School / University / Work Name: _____________________________________________________________________________________

Date of Joining: _______________________________________________________________________________________________________

Home address: ________________________________________________________________________________________________________

City: ______________________________________________________ State/Province: ____________________________________________

Postal/Zip Code: ________________________________________ Country: ____________________________________________________

Telephone: _____________________________________________ Cell no.: ______________________________________________________

Email: _________________________________________________________________________________________________________________

PARENTS DETAILS:

Mother’s name: _______________________________________________ Father’s name: _______________________________________________________

Mother’s phone: ______________________________________________ Father’s phone: _______________________________________________________

Person’s Authorized to pick up child: _________________________________________________________________________________________________

Emergency contact*: _________________________________________ Relationship: __________________________________________________________

Phone: _________________________________

Please specify if any health problems*: ______________________________________________________________________________________

ACADEMIC FEES:

Academic fee for each activity is listed below for each art/sport. FEES MUST BE PAID IN FIRST WEEK OF THE MONTH. Rs. 300 will be registration fees.

PARENTS STATEMENT

I hereby state that (name) _____________________________________________ is in good mental and physical health condition to participate in the activity provided by Horus karate federation of India include but not limited to all aspects of all martial arts, Fight Drills & Other Sports activity and competitions. I am fully aware that any activity involving motions, height or activity creates the possibility of serious injury. I hereby release HORUS KATARE FEDERATION OF INDIA, its teacher/ Coach and it’s staff from liability to the above name athlete, of the person claiming through him/her, arising from injury to the person or property of the above named athlete occurring in the premises of HORUS/SCHOOL/DOJO, including and event sponsored or sanctioned by HORUS FEDERATION OF INDIA, and or travel to and from such activities.

I understand that HORUS KARATE FEDRATION OF INDIA, has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that myself or my son/daughter/child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior in school or out of camp, etc.) or becomes involved in any activity or with any persons not associated with HORUS KARATE FEDERATION OF INDIA, or its scheduled program and that HORUS KARATE FEDERATION OF INDIA, has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply.

Please do your best to come to Hours academy every day.

Signature: ___________________________________ Date: __________________________

Registration Form