Fall Camp

Student's First Name*

Student's Last Name*

Student's Date of Birth*

Parent's First Name*

Parent's Last Name*

Parent's Phone Number*

Parent's Email*

Emergency Contact*

Emergency Contact's Phone Number*

Choose a Program

Weekly Program with Free Testing $180/weekDaily Program with No Testing $50/day

If you chose the Daily Program, please select the date(s) below:
Monday, October 7Tuesday, October 8Wednesday, October 9Thursday, October 10Friday, October 11

Please list any allergies:

How did you hear about us?

PAYMENT

If you are currently enrolled with Chandler MMA, the payment method associated with your account will be charged within 24 business hours from enrollment submission. New Student Enrollment, please call us at 480.234.3683 or stop by the school during our business hours to process your payment. No Refunds.

WAIVER

By checking "I Agree to the Terms & Conditions", you represent that you (the student) have no emotional, mental or physical illness that could impair training or make the training injurious. While every effort will be made on our part to make the classes and facilities as safe as possible, you are aware that any physical activity has the potential for injury and you waive any claim of accidental and/or negligent tort damage against us and/or our principal officers or instructors resulting from the activity. I hereby acknowledge an assumption of risk by accepting and agreeing to allow my child/myself to participate in material arts and/or other related activities including karate camps & field trips.

ELECTRONIC SIGNATURE CONSENT

By checking "I Agree to the Terms & Conditions", you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to Chandler MMA, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

*I agree to the Terms & Conditions by selecting this checkbox.

THE CHECK BOX MUST BE SELECTED IN ORDER TO SUBMIT THIS FORM.

Parent e-Signature*

Please send us a message if you have any questions.