A-PLUS Martial Arts TKDD
3239 Brinkley Rd. Temple Hills, MD (301) 505-8600
(School Program Open to Current Students, Beginners, & the General Public)
Buyer/Parent Name: ______________________________________________ Sex: M F
First Middle Last
Phone: Home ( ) ________________, Work ( ) _________________, Cell ( ) _____________________
Address: ____________________________________________________________________________________
SS# NEEDED FOR TAXES: ________________________ EMAIL _____________________________________
Buyer/Parent Name: _________________________________________ Sex: M F
First Middle Last
Phone: Home ( ) ________________, Work ( ) _________________, Cell ( ) _____________________
Address: ____________________________________________________________________________________
Student Name(s): 1. ______________________ 2. ______________________ 3._______________________
Date of Birth: 1. ____/____/____ Age _____ 2. ____/____/____ Age ____ 3. ____/____/____Age_____
School Attending 1._______________________2._______________________3._______________________
Authorized Pick-up and Emergency Contact name/phone/address: 1.________________________________________________________________________________________________
2.________________________________________________________________________________________________
3._________________________________________________________________________________________________________
Health Condition (LIMITATIONS)
_________________________________________________________________________________________________
Has your child been hospitalized in the past year: Y/N EXPLAIN ____________________________________________
_______________________________________________________________________
REGISTRATION COST: $100. Per child due every school year. (Circle all that apply below)
BIWEEKLY PAYMENTS AM & PM SESSION PM SESSION ONLY ALL DAY SESSION
· Kindergarten – 5th $210.00 $180.00 $15. per day
· 6TH -8TH $200.00 $180.00 $10. per day
· PRE- K (PM ONLY) / HEAD START $220. BIWEEKLY
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· Add night class/$10 weekly ____ M/W ____ T/TH ____Black Belt ____
· Saturday Class $15 (12-2PM) ____________ Saturday Camp $10 (2 pm – 4 pm) DATES WILL BE POSTED
Payment Options: Biweekly_______ Monthly _________ Other__________ Total due ______________
APLUS MARTIAL ARTS TKDD handbooks can be found on our webpage: aplusmartialarts-templehills.com
All tuition is due Friday in advance for two weeks. In the event that a payment is late only cash will be an acceptable form of payment. After Monday morning your tuition is considered late please add a $15.00 late fee to your child’s payment per week. If tuition is more than one week late your child will not be able to attend A- Plus Martial Arts. A- Plus will not hold a place for your child in its program if payment is not immediately made. There is a $40.00 return check fee for all returned checks and checks will not be accepted for 60 days thereafter. If a second check is returned then future checks will not be accepted. Tuition is due regardless of attendance. A two week written notice must be given to withdrawal any child from the program. A-PLUS RESERVES THE RIGHT TO TAKE CIVIL ACTION AGAINST ALL UNPAID ACCOUNTS THAT ARE TWO WEEKS IN ARREARS. NO TAX INFORMATION WILL BE GIVEN OUT IF ACCOUNTS ARE NOT PAID IN FULL.
Buyer’s Signature: __________________________________
CONSENT AND RELEASE FORM
I, the undersigned member, hereby acknowledge that I am aware of the strenuous physical exercise involved in participating in the APLUS MARTIAL ARTS PROGRAMS & SERVICES. I hereby consent to hold the sponsors free of any and all liability, claims, or actions whatsoever, arising from any injuries, accidents, illnesses, etc., due to the attendance at A-PLUS Martial Arts TKDD Programs and Services. I hereby consent to allow the sponsors to take such action as is necessary to contact and provide emergency and medical assistance.
NO CHILD WILL BE ALLOWED TO PARTICIPATE IN ANY PHYSICAL ACTIVITY WITHOUT PARENT CONSENT. CHILDREN MUST HAVE A SIGNED CONTRACT IN ORDER TO PARTICIPATE IN ACTIVITIES. EVERYONE MUST REMOVE SHOES BEFORE ENTERING THE MAT AREA.
Parents are responsible for relaying all the policies & rules of APLUS MARTIAL ARTS to their child before martial arts classes are started. Please inform staff of any health conditions or injuries.
I, the undersigned, upon being permitted to join the APLUS MARTIAL ARTS PROGRAMS AND SERVICES, will obey the rules. I will endeavor to conduct myself in the manner of a student of A PLUS MARTIAL ARTS in class & in my daily life and I will never do anything to bring disgrace upon the art. I am fully capable of understanding and reading the English language and have answered everything honestly and completely. I hereby swear that I will faithfully fulfill my duty. It is understood that APLUS is not a daycare, but an afterschool martial arts program. All students must take part in our taekwondo or fitness classes. All sick students must be picked up from school and will not be allowed in the building.
Buyer’s Signature: ___________________________
We offer a belt testing every quarter but all children may not be ready. Children who are ready will receive an application and must test to receive their new belt. If a child missed one or more testing cycles, they may be excused from the program. Tuition must be current in order to qualify for testing.
Buyer’s Signature: ___________________________
My child/children: ________________________________ will take part in the school year(s) (Start date_______ - June __, 2013) at A PLUS MARTIAL ARTS. My tuition will remain $_________ every two weeks that total $________ for the school year of 2012/13. To keep this rate I understand that registration is due before August 1, for each school year.
My child will attend all day session when school is closed Y / N_________
Buyer/ Parents name: ________________________ Signature: ______________ Date: _______________
A Plus staff member: ________________________ Signature: ______________ Date: _______________
A Plus Martial Arts Photo
A Plus Martial Arts includes photos of students, teachers, and school activities on its website. Though the names of the staff and administration will regularly be used, it is our policy that the full names of the students will not. Occasionally it may be necessary to use the first name of a student but again last names, addresses, and/or telephone numbers will never be used.
____ We/I hereby give permission for A Plus Martial Arts to use photos along with first names on the A Plus Martial Arts websites (including Facebook) and other electronic forms of communication.
____ We/ I hereby give permission for A Plus Martial Arts to use photos only without first names on the A Plus Martial Arts website and other electronic forms of communication.
____ We/ I hereby do not give permission for A Plus Martial Arts to use photos only on the A Plus Martial Arts website and other electronic forms of communication.
I understand that I am not allowed to post photos of another APlus student on public forums without written permission.
Child’s Name: __________________________ Parent or Guardian: ___________________________
Date: __________________________