Registration

After School Program

Safe, structured after-school care with martial arts, homework help, and character development.

Step 1 of 4

Student Details

Student First Name *

Required.

Student Last Name *

Required.

Date of Birth *

Required.

Gender

Current Grade *

Required.

School Name *

Required.

School Name (other)

Pickup Days *

Mon Tue Wed Thu Fri

Medical Conditions / Allergies

Step 2 of 4

Parent / Guardian

First Name *

Required.

Last Name *

Required.

Email *

Valid email required.

Cell Phone *

Required.

Work Phone

Authorized Pickup Persons

List all individuals authorized to pick up your child (besides the parent above).

Step 3 of 4

Emergency Contact

First Name *

Required.

Last Name *

Required.

Phone *

Required.

Relationship *

Required.

Step 4 of 4

Agreements & Signature

Monthly Rate

$250/month

Full after-school coverage Mon–Fri. Includes snack, homework help, and karate classes.

I agree to the Participation Waiver and Release of Liability for the After School Program.

I authorize Karate Champions Club to obtain emergency medical treatment for my child if I cannot be reached.

I understand that monthly tuition is due on the 1st of each month. A $25 late fee applies after the 10th.

Electronic Signature *

Signature required.

Date *

Required.

🎒

Enrolled!

Your child is enrolled in our After School Program! We'll contact you within 24 hours to confirm the start date and share a welcome packet.

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