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Kids 3.5 - 13
>
3.5 - 4 Tiny Tigers
5 - 8 Little Warriors
8 - 13 Young Dragons
Teens & Adults 13+
Trial Class Waiver
Register for Class
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3.5-4yo Registration
5-8yo Registration
8-13yo Registration
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Ephrata Martial Arts
Homeschool Registration
2021 Spring Semester
We recommend your child watches a class before you register them, and ages 5-13 are also welcome to participate in a free trial class.
If registering more than one family member, please list Student #1 as the member with the highest membership rate.
The spring 2021 semester is 16 weeks from January 5 - April 29.
*
Indicates required field
Student #1 Name
*
Student #1 Birthdate
*
Student #1 Class Placement.
*
Ages 5-7: Tues 10:00-10:45am [FULL]
Ages 5-7: Thurs 11:00-11:45am [2 openings]
Ages 8-13: Tues 10:45-11:45am
Ages 8-13: Thurs 10:00-11:00am
Ages 8-13: Additional evening/Saturday classes
Select monthly rate
*
Select if applicable
Ages 5-7: 1x/week - $55
Ages 5-7: 2x/week - $95
Ages 8-13: 1x/week - $65
Ages 8-13: 2+x/week - $110
Student #2 Name
*
Student #2 Birthdate
*
Student #2 Class Placement
*
Ages 5-7: Tues 10:00-10:45am
Ages 5-7: Thurs 11:00-11:45am
Ages 8-13: Tues 10:45-11:45am
Ages 8-13: Thurs 10:00-11:00am
Ages 8-13: Additional evening/Saturday classes
Select monthly rate
*
Select if applicable
Ages 5-7: 1x/week - $55
Ages 5-7: 2x/week - $95
Ages 8-13: 1+x/week - $55
Student #3 Name
*
Student #3 Birthdate
*
Student #3 Class Placement
*
Ages 5-7: Tues 10:00-10:45am
Ages 5-7: Thurs 11:00-11:45am
Ages 8-13: Tues 10:45-11:45am
Ages 8-13: Thurs 10:00-11:00am
Ages 8-13: Additional evening/Saturday classes
Select monthly rate
*
Select if applicable
Ages 5-7: 1x/week - $55
Ages 5-7: 2x/week - $95
Ages 8-13: 1+x/week - $55
Mother/Guardian (if under 18)
*
Mother/Guardian Cell
*
Father/Guardian (if under 18)
*
Father/Guardian Cell
*
Student Cell
*
Home Phone
*
Address
Street
*
City
*
State
*
Zip Code
*
Email (our primary communication with you)
*
Emergency Contact Name & Relation
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Emergency Contact Phone Number
*
Medical conditions or allergies?
*
It can be helpful for us to know if a student is autistic, ODD, ADD, ADHD, etc.
How did you hear about us / who referred you?
*
SIGNED AGREEMENTS
LIABILITY
I agree not to hold Justin Press, Ephrata Martial Arts, and/or its teachers or associates responsible for any loss, injury, accident, or liability that might occur while I or my child are participating in classes, competitions, etc. I further state that all students listed on this registration are in good health and are not restricted from any physical activities such as martial arts, etc.
Please sign that you have read and agree to the above liability statements.
*
Type full name.
FINANCIAL OBLIGATION
I have received and read the 2021 membership rates and understand that I am committed and liable for the entire semester, and that there is an early cancellation fee if I do not wish to fulfill the contract.
I understand that the homeschool session requires an ACH (auto withdrawal) form to be completed for monthly payments unless if the amount for the entire session is paid in advance.
(The ACH form can be acquired at our studio or by requesting through email)
Please sign that you have read and agree to the above financial obligation statements.
*
Type full name.
GENERAL POLICIES
I agree to abide by the Ephrata Martial Arts code of ethics, dress code, and general policies.
(Please note that this includes not to distract the students and/or instructor(s) by talking or signaling to them during class or by making excessive noise, to take all phone calls outside, no rolling around/punching/etc while waiting for class, students keep a clean uniform and bow before stepping on/off the mats, no shoes on the training mats, and to wear shoes in the bathroom.)
Please sign that you have read and agree to the above statement.
*
Type full name.
MEDIA RELEASE WAIVER
Ephrata Martial Arts is hereby granted permission to take photographs / video of any and all students to use in print or electronic publication. As student or legal guardian of student, I do understand that photos will eventually be removed from the website as pictures from the new classes / teams are put in its place. For internet safety, I understand that Ephrata Martial Arts will only use my name/my child’s name on the internet if I grant them permission (sign below). I also realize that my name/my child’s name may be mentioned in local newspapers should his or her photo be taken and used for that purpose. I am confident that photos of my student will be appropriate and of good taste. I hereby give Ephrata Martial Arts exclusive rights for all media use of my child’s image. This includes all print, non-theatrical, home video, CD-ROM, internet and any other electronic media, advertising, posters, social media and other promotional materials that may be created in the future. Ephrata Martial Arts also has the right to use and intertwine (with or without other materials) in full or portion any photographs / video footage taken as a result of participating in Ephrata Martial Arts classes and events.
*This photo waiver applies to all classes, social events and public events that are associated with
Ephrata Martial Arts
w
hen posting or using pictures/other media forms of the student:
Choose One:
*
I DO also give permission to Ephrata Martial Arts to use my name/my child's first name and last initial if needed in any internet, social mdedia, print and/or media advertising.
I DO NOT give permission to Ephrata Martial Arts to use my name/my child’s name (partial or full) in any Internet, social media, print and / or media advertising. I understand that I/my child may be asked to leave a specific area of an event where photos or interviews are being taken to ensure that they are not included in media. I also understand that Ephrata Martial Arts is not responsible for other parents and/or bystanders or the general public’s ability to post students' pictures and tag my student's name on the Internet or social media sites.
Signature (of Parent/Guardian if student is Under 18) Media Release Waiver
*
Type full name.
REGISTRATION FINANCIAL AGREEMENT
With the submission of this form is due this month's tuition in part or in full depending on your start date. This payment will be
*
Paid monthly by ACH auto withdrawals
Paid by cash or check for entire session amount up front.
Coupon code / advertised special to be applied?
*
Intended start date.
*
This helps us to properly prorate the month for you if you are beginning part way through. Write N/A for Tiny Tigers Session.
Submit
Home
About
Meet the Team
Testimonials
Contact
Classes
Class Schedule
Kids 3.5 - 13
>
3.5 - 4 Tiny Tigers
5 - 8 Little Warriors
8 - 13 Young Dragons
Teens & Adults 13+
Trial Class Waiver
Register for Class
>
3.5-4yo Registration
5-8yo Registration
8-13yo Registration
Teen/Adult Registration
Videos
Gallery