Fitness for Focus - Uptown

Kids Karate 131 West 72nd Street

between Columbus and Amsterdam Studio 2R

Tel. 646.213.0973

(Please circle: 1. class time, 2. lesson fee, and 3. Uniform Fee and mail to address below with payment)

Mondays, beginning Sept. 24 - Ending Jan. 21 (14 Weeks) No classes on 10/8, 11/19, 12/24, 12/31

4:30 – 5:00 pm 4 - 7 y.o. (1/2 hour ) Studio 2R 5:00 – 6:00 pm All Ages ( 1 hour ) Studio 2R

Early Registration (Must pay by 9/7/2012)

$ 425. $ 675.

Regular Registration (pay after 9/7/2012)

$ 575. $ 795.

Karate Uniform Fee: $50

Student Name _____________________________________________________________

Telephone ________________________ Alt Telephone ____________________________

Address __________________________ City _____________ State ___ Zip____________

Student Date of Birth ____________________ Height _____________ Weight __________

Parent / Guardian e-mail address_______________________________________________

Parent or Guardian Name ____________________________________________________ (please print)

Parent / guardian realizes that there is the possibility of injury in any exercise or activity. The parent or guardian undersigned agrees to hold Fitness for Focus, Inc., and their instructors, employees and contractors harmless in case of any mishap, accident or injury before, during, or after activities from this date forward. All participants are advised that they should have their doctor’s approval for activity. The benefits of karate training show in a student over a sustained effort over multiple sessions. A full refund will be given with a letter in writing 48 hours before the first class. A 50% refund will be given with a letter in writing before the second class whether or not the student attends the first class. No refunds will be given after the 2nd class.

Parent or Guardian

Signature ___________________________________ Date _______________________

Please mail this form with your check Payable to:

Fitness for Focus, Inc. 130 Seventh Ave., Suite 342, NYC 10011

Sensei Glenn http://fitnessforfocus.com

Monday, September 24

Girls

Boys

Help your child develop: Self-Confidence, Focus,

Concentration, Fitness and Control

Classes

Start

Family Members Registered

2 - (10% discount) 3 - (20% discount) from each registration