STUDENT ENROLLMENT

READY TO START
THE JOURNEY?

Complete the student registration form below to help Simo’s Academy prepare for your child’s training. A parent or guardian should complete this form.

ONLINE REGISTRATION
CHELSEA & EVERETT
PARENT / GUARDIAN FORM

Student Full Name

Date of Birth (MM/DD/YYYY)

Student Age

Gender

Male
Female

School

Grade

Parent/Guardian Full Name

Relationship to Student

Phone Number

Email Address

Home Address

Emergency Contact Name

Code Typed Acknowledgment

Relationship to Student

Phone Number

Liability Waiver, Assumption of Risk & Medical Authorization

I have carefully read this Liability Waiver, Assumption of Risk, and Medical Authorization. I understand its contents and voluntarily agree to its terms.

Assumption of Risk

I understand that participation in karate, kickboxing, Muay Thai, fitness training, drills, and other martial arts activities involves inherent risks, including but not limited to bruises, cuts, sprains, strains, broken bones, concussion, and other serious injuries.

I voluntarily allow my child to participate in the programs offered by Simo’s Karate & Kickboxing Academy and acknowledge that these risks cannot be completely eliminated.

Health Certification

I certify that my child is physically able to participate in martial arts activities. I have disclosed any medical conditions, allergies, medications, or physical limitations that may affect my child’s participation.

I agree to notify the academy immediately if my child’s medical condition changes.

Medical Authorization

In the event of an illness or injury requiring emergency medical care, and I cannot be reached promptly, I authorize Simo’s Karate & Kickboxing Academy and its instructors to seek emergency medical treatment for my child.

I understand that I am responsible for any medical expenses incurred.

Release of Liability

To the fullest extent permitted by law, I release and hold harmless Simo’s Karate & Kickboxing Academy, its owner, instructors, assistant instructors, volunteers, employees, and affiliated facilities from claims arising out of injuries or damages resulting from the ordinary risks of participation in academy activities.

This release does not apply to claims resulting from gross negligence, reckless conduct, or intentional misconduct where such rights cannot legally be waived.

Rules and Safety

I understand that my child is expected to follow all academy rules and safety instructions at all times.

Failure to follow instructor directions or academy rules may result in removal from class or suspension from participation.

Please Select One

YES – I give permission for Simo’s Karate & Kickboxing Academy to photograph and/or record my child and to use these images or videos for academy-related promotional and educational purposes.
NO – I do not give permission for my child to be photographed or recorded for promotional purposes.

Permission to Use Photos & Videos

Throughout the year, Simo’s Karate & Kickboxing Academy may take photographs and/or videos of classes, training sessions, belt promotions, tournaments, demonstrations, special events, and other academy activities.

These photos and videos may be used for educational, promotional, and marketing purposes, including:

Academy website
Social media pages (Facebook, Instagram, etc.)

No compensation will be provided for the use of these photos or videos.

This consent is optional. Please select YES or NO.

Photo & Video Release Acknowledgment

I have read and understand this Photo & Video Release Authorization. I understand that I may update my decision in writing at any time.

Student & Parent Code of Conduct

Student: I have read and understand the Student & Parent Code of Conduct. I agree to follow these expectations and understand that failure to do so may result in disciplinary action, including suspension or dismissal from the academy if necessary.

At Simo’s Karate & Kickboxing Academy, we are committed to developing disciplined, confident, respectful, and responsible individuals. To maintain a safe and positive learning environment, all students and parents are expected to follow the Code of Conduct below.

Student Responsibilities

As a student of Simo’s Karate & Kickboxing Academy, I agree to:

Treat instructors, staff, fellow students, and visitors with respect and courtesy.
Follow all instructor directions promptly and respectfully.
Arrive on time and ready to participate in class.
Wear the required academy uniform and safety equipment.
Practice good sportsmanship and encourage others.
Use self-control at all times and never use martial arts skills to bully, threaten, or fight outside the academy.
Keep the training area clean and treat academy equipment with care.
Demonstrate honesty, integrity, discipline, and a positive attitude during every class.
Do my best in every class and strive to improve both physically and mentally.

Parent/Guardian Responsibilities

As the parent or guardian, I agree to:

Support my child’s learning and encourage respect, discipline, and good behavior.
Ensure my child arrives on time and is picked up promptly after class.
Inform the academy of any medical conditions or changes that may affect my child’s participation.
Notify the academy if my child will be absent.
Treat instructors, staff, students, and other families with respect.
Allow instructors to conduct classes without interruption or interference.
Help reinforce the academy’s values and expectations at home.

Academy Values

At Simo’s Karate & Kickboxing Academy, we believe martial arts is more than learning techniques. We strive to build:

Respect • Discipline • Confidence • Self-Control • Leadership • Integrity • Perseverance • Humility

Our Philosophy

Martial arts develops more than physical ability. It builds the discipline, confidence, respect, and self-control students carry into everyday life.

Parent/Guardian Code of Conduct Acknowledgment

Parent/Guardian: I have read and understand the Student & Parent Code of Conduct. I agree to follow these expectations and understand that failure to do so may result in disciplinary action, including suspension or dismissal from the academy if necessary.

Typed Parent/Guardian Name

First

Last

Date (MM/DD/YYYY)

Registration Accuracy Acknowledgment

I certify that the information provided on this registration form is true and accurate. I understand that it is my responsibility to notify Simo’s Karate & Kickboxing Academy of any changes to my child’s contact or medical information.

Privacy Notice: Information submitted through this form will be used by Simo’s Academy to process student registration, communicate with the parent or guardian, and maintain appropriate enrollment and emergency-contact information. Please do not submit medical, financial, Social Security, password, or other unnecessary sensitive information through this form. Read our Privacy Policy.

Student-Registration

READY TO STARTTHE JOURNEY?