• 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+
    • Self Defense
    • Trial Class Waiver
    • Register for Class >
      • 3.5-4yo Registration
      • 5-8yo Registration
      • 8-13yo Registration
      • Teen/Adult Registration
  • Videos
  • Gallery
  Ephrata Martial Arts

    Add Family Member to Existing Membership


    It can be helpful for us to know if a student is autistic, ODD, ADD, ADHD, etc.

    ​CONTRACT & RATES - select from one of the drop down menus below

    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.

    Type full name.
    FINANCIAL OBLIGATION
    I have received and read the 2019 membership rates and understand that I am committed and liable for month to month (until a written notice is received for cancellation), 6 months, or 12 months according to the commitment period I chose on this form, and that there is an early cancellation fee if I do not wish to fulfill the contract. I understand that for my registration to be complete I must pay the full or pro rated tuition for the current month.

    I agree to add the monthly amount chosen above to either our cash/check payment (no contract) or our monthly ACH payment (6 & 12mo contracts) that is already established.
    ​
    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.)
    ​
    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 when posting or using pictures/other media forms of the student:
    ​
    Type full name.

    REGISTRATION FINANCIAL AGREEMENT

    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
Ephrata Martial Arts,  (717) - 738 - 2244
248 W. Fulton Street, Ephrata, PA 17522
  • 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+
    • Self Defense
    • Trial Class Waiver
    • Register for Class >
      • 3.5-4yo Registration
      • 5-8yo Registration
      • 8-13yo Registration
      • Teen/Adult Registration
  • Videos
  • Gallery