Enter Your Name You Prefer and Your Last Name
Previous Martial Arts Experience
Mailing Address
Home Phone Number
Cell Phone Number
Email Address
Emergency Contact and Number
I do hereby certify to Garriss Martial Arts, The Town of Ayden Recreation Department, & Craven County Recreation & Parks that the above participant is in good health and is physically able to participate in the Martial Arts Program.  I or we the guardians/parents of the above participant will not hold Garriss Martial Arts, The Town of Ayden, The City of New Bern, Craven County Recreation and Parks, or any associate of Tim Garriss responsible for any accident to me/or my son/daughter/dependent going to and from and during the Martial Arts or Related Program.  I/or we the parents/guardians of the above participant authorize any associate of Garriss Martial Arts or Recreation Programs' personnel, paid or volunteer, to take my child to a doctor or the emergency room of the hospital in the event it is deemed necessary, and I or we the parents/guardians agree to pay any and all medical expenses incurred.
Allergies and/or Special Medical or other Considerations
Tell us something about level..hobbies...other....

Insurance Information
I have read and Agree to the release agreement
I/We the Parents/Guardians have read and Agree to the release agreement
I Do Not Agree
I/we the parents/guardians do not agree