Karate Additional Family Member

Please use this form and payment option for additional family members taking Karate. This will create a second recurring payment.

Karate Registration for additional family member

Once form is completed you will be redirected to the payment page (this may take a moment). You will NOT be registered for Karate until payment is completed. Please contact us if you have any difficulty.

Parent Name

Email Address

Phone (Emergency Contact – add name if different from parent listed)

Participant Name

Participant’s Age

Any special needs or medical conditions we should be aware of? Are any accommodations necessary? Please note that instructor may contact you for more information and you may need to assist your child if instructor cannot accommodate your child’s needs.

I have a current Leu family membership

yes

renewing now

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Karate Additional Family Member

Karate Registration for additional family member

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Karate Registration for additional family member

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