AFTER SCHOOL FORM

AFTER SCHOOL KARATE ACADEMY
Parent or Legal Guardian
Date
Address
Email
Family Physician Name
Phone
Student Information
Name
(M/F)MaleFemale
Date of Birth

Name
(M/F)MaleFemale
Date of Birth

Name
(M/F)MaleFemale
Date of Birth

School Name
School Grade

In case of Emergency:
Name
Tel.

Name
Tel.

Name
Tel.

Before School Program:After School Program:Before & After School Program:Snack:Homework Club:
Initials

Payment Policies: Tuition is due on Wednesday for the following week. Payments not received on Wednesday are subject to $20.00 penalties. If payment has not been received by Monday at 12:00pm. We will not be able to pick up your child until full payment is received. Should you need to withdraw your child for any reason from our program, two full weeks notice is required. Returned checks are subject to a $25.00 surcharge.

Initials

Pick-Up Time: After school care ends at 7:00 pm. If you are unable to pick up your child up by then, please let us know in advance, if possible. A late fee of $1 per minute after 7:05 pm. Payment must be made at time of pickup and sign out, on late pickup sheet. Please remember to sign your child out each day and let us know in advance if someone else is coming to pick your child up.

Initials

Sickness/Absenteeism: Please notify us as soon as you know your child will not be attending. This will allow for our program to run smoothly and eliminate the potential for unnecessary delays in our transportation schedule. A $10.00 fee will be charged, if we are not notified of your child's absense by 12:00pm. "If your child is not attending for the week, the full week's tuition will still be required (including winter and spring break week)."

Representative
Signature

Our Philosophy

The purpose of After School Karate Academy After School Program is to offer discipline by fostering mental and physical enhancement as well as encouraging character development. This is done by teaching Martial Arts, encouraging good behavior at our facility as well as at home and school. Although this program is designed to teach discipline, your child will have fun in the process.

Payment Policies:

Tuition is due on Wednesday for the following week. Payments not received on Wednesday are subject to $20.00 penalties. If payment has not been received by Monday at 12:00 pm. We will not be able to pick up your child until full payment is received. Should you need to withdraw your child for any reason from our pro­gram, two full weeks notice is required.

Returned checks are subiect to a $25. 00 surcharge.

Bad Check Fee.

If your checks for any payments under this contract are returned for insufficient funds on the second presentment, you may be charged a bad check fee of $25.00 or the maximum amount permitted by law, and when applicable, a late charge as well as any other charges allowed by law.

Pick-Up Time:

After school care ends at 7:00 pm. If you are unable to pick up your child up by then, please let us know in advance, if possible. A late fee of $1 per minute after 7:05 pm. Payment must be made at time of pickup and sign out, on late pickup sheet. Please remember to sign your child out each day and let us know in advance if someone else is coming to pick your child up.

Sickness/Absenteeism

Please notify us as soon as you know your child will not be attending. This will allow for our program to run smoothly and eliminate the potential for unnecessary delays in our transportation schedule. A $10.00 fee will be charged, if we are not notified of your child's absence by 12:00 pm.

Uniform

All participants will be issued a uniform during their first week. It is very important that they bring their uniform everyday and it should be clean and in good repair. We have karate instruction each day and the uniform is required for class participation. If your child repeatedly forgets his/her uniform, (3 times) a new one will be issued and your account will be billed $40.00.

Our School Closings

After School Karate Academy follows Prince George's County Public School calendar for closings.

Release of Liability.

Members and their guests in using the schools and any equipment, do so at their own risk. The institute shall not be liable for any damages arising from personal injuries sustained by members and guests, in, on, or about the premises of the Institute. The Institute assumes no responsibility for the loss of, or damage to, any person property belonging to a member or guest while on the Institute premises.

Members represent that he or she is in good physical condition and able to use the equipment provided and to participate in programs made available by the institute. The institute represents that its personnel are trained in providing equipment and instruction.

As we are aware, very young children are prone to mishaps. Although we will give every effort to have adequate supervision, occasionally acci­dents will happen. In the instance that an emergency arises we would need your specific permission to transport and have your child treated by a professional caregiver/physician etc.

This also serves as specific permission to pick your child up from their respective school and transport them back to our studio for karate. After School Karate Academy reserves the right to remove any child from the program. This is for the safety and well being of all students and staff.

Governing Law.

This contract will be governed by laws of the State of Maryland and of the United States. If any part of this contract is unenforceable, this will not make any other part unenforceable.

NOTICE: ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS AND SERVICES OBTAINED PURSUANT HERTO OR WITH THE PROCEEDS HEREOF, RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER.