Karate Class Ongoing Every Wednesday
Fill out the form carefully and sign up of each participant.
Class Date
Beginners Class - September 2nd, 9th, 16th, and 23rd - 5:30pm - 6:30pm
Class Date
Advance Class - September 2nd, 9th, 16th, and 23rd - 6:30-7:30pm (Yellow/Orange Belts)
Class Participant Name
*
First Name
Last Name
Family Name
*
First Name
Last Name
City
*
Age
*
Gender
*
Male
Female
N/A
Number in Household
*
Over age 62
*
Mobile #
*
-
Area Code
Phone Number
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
E-mail
*
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September Monthly Family Donation
$100.00
$
100.00
September Monthly Family Donation
September IRC Reimbursement
$100.00
$
100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles
Already donated this month / Self Determination
Free
$
Free
Please hit PayPal to check out. (Zelle - rocknourdisabilities@gmail.com)
Total
$0.00
$
0.00
Payment Methods
Debit or Credit Card
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make your payment.
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