Hempfield Rec / Isshinryu Karate Registration - Hempfield recCenter

Isshinryu Karate Form

Child's Name(Required)

First Last

Child's Gender(Required)

Grade(Required)

Child's Birthdate(Required)

Child's Height(Required)

Child's Weight(Required)

Child's T-Shirt Size (please pick one)(Required)

Guardian Name #1(Required)

First Last

Phone(Required)

Guardian Name #2

First Last

Phone

Primary Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Signature(Required)

Date(Required)

Comments

This field is for validation purposes and should be left unchanged.