Tiny Tigers Registration

Our Tiny Tigers program for ages 3.5 - 4 is scheduled as 8 week sessions.
$20 is due prior to the start of the session to hold their place, as well as uniform cost if they do not have one yet.
This 30 minute class has options to attend on Tuesday, Wednesday, or Saturday.

Due to the class structure and short commitment period, we do not offer the free trial class like we do for our other age groups.
However, we do encourage you to visit with your child to watch either an ongoing Tiny Tigers session or our Little Warriors class for ages 4-7.
This will allow your child to be more familiar with our studio and for you to get a better feel for what we teach.
You can read more about the class here.

* Indicates required field

Student Name *

Student Birth Date *

Class Time *

Wednesday 5:00 pm, begins Jan 29 --- (WAIT LIST) Saturday 9:30am, begins Feb 1 [no class Feb 15] --- (2 openings)

For this class students are to wear our uniform t-shirt with plain black sweatpants, leggings, or knee length shorts. Please select their size below if you need to purchase a shirt for $25. *

Mother/Guardian (if under 18) *

Mother/Guardian Cell *

Father/Guardian (if under 18) *

Father/Guardian Cell *

Home Phone *

Address

Street *

City *

State *

Zip Code *

Email (our primary communication with you) *

Emergency Contact Name & Relation *

Emergency Contact Phone Number *

Medical conditions or allergies? *

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. *

FINANCIAL OBLIGATION
I agree to pay $20 prior to the start of the session, and an additional $60 if they show readiness to continue beyond the second class. I understand that there are no refunds for missed classes, and a makeup class will be scheduled if we close due to weather.

Please sign that you have read and agree to the above financial obligation statements. *

EPHRATA MARTIAL ARTS 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, to keep shoes off the training floors, and to wear shoes in the bathroom.)

Please sign that you have read and agree to the above statement. *

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:

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 for Media Release Waiver *

REGISTRATION FINANCIAL AGREEMENT

Our payment, due now, will include *

$25 for uniform t-shirt $20 for the first 2 classes of the session If the student shows readiness to participate and continue the session I agree to an additional $60 payment due at the 3rd class.

This payment will be *

paid with cash or check and dropped off at the studio. paid with check and mailed to the studio at 248 W. Fulton Street, Ephrata, PA 17522 paid by auto withdrawal from our checking account (only if you've previously established this with us).

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