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Junior Nin-Ja Registration

* Please register one child per registration form. All fields require an answer.
Parent's Name:
Address:
City
State:
Zip Code:
Phone #:
E-Mail Address:

Child's Name:
Date of Birth:	e.g. 1/15/2009
Child's Age:
Allergies:	No Yes If yes, please explain:
Any sickness, health diagnoses or injuries TriJohn Martial Arts Program should be aware of?
	No Yes If yes, please explain:
On a level between 1 and 10 (10 being the greatest), how will you rate your child’s physical activities:
On a level between 1 and 10 (10 being the greatest), how will you rate your child interactions with his/her pals:
On a level between 1 and 10 (10 being the greatest), how will you rate your child’s diet, Note: lots of fast foods being at the lesser end:
Do you consider your child an introvert or extrovert
Has your child ever complained of being bullied: No Yes
If your child is of an evaluation age in school, what is the grade point average, e.g. A, B, C, D, F or Good, Satisfactory, Excellent, Needs Improvement:
How do you feel your child may benefit by being part of the Junior Nin-Ja Program:
Terms of Agreement:
Times of Services: The Junior Nin-Ja Program will be scheduled on Saturday afternoons between the hours of 3:00 p.m. and 4:00 p.m. (classes will start on time)- Parents/guardians will be notified via email or telephone if and when more classes are added. Parents are asked to pick up their child or children no later than 15 minutes after the completion of classes. Additional charges may apply if your child or children isn't picked up within the allocated 15 minutes grace period. Fee for Services: The TriJohn Fitness and Martial Arts Junior Nin-Ja Program has a onetime registration & processing fee in the amount of $180.00, this fee will included: - First month tuition - Uniform (top, bottom and starter white belt) - Back Pack carrying bag - Processing Fee Each additional month, payments shall be made in the following manner during first week of each month @ $80.00. - Check or Money Order paid on location (Payment Drop Box) - Mail to: TriJohn Fitness Inc. P.O Box 1103 Dumfries, Va. 22026 - On the web at: www.trijohnfitness.com - Note: There will be a $35.00 non-refundable processing fee on all returned checks 1. I understand and agree that it is my responsibility to inform TriJohn's Staff of any conditions or changes in my child's health, now and ongoing, which might affect his/her ability to train safely and with minimal risk of injury. 2. I understand that all sessions are non-transferable and non-refundable 3. I understand that TriJohn's Staff will thoroughly explain to my child / children to please tell someone when he or she isn't feeling well or may be suffering an injury unbeknownst to TriJohn's Staff or his/her parents
I have read and understand this term

Junior Nin-Ja Registration

* Please register one child per registration form. All fields require an answer.