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Clement Martial Arts Spring 2023 Registration

Clement Classes

Clement Martial Arts:
Spring 2023 Registration

January 23 - May 12

Clement Classes: Westminster Campus
2303 Double Churches Road
Columbus, GA 31909

Registration fee must be paid upon completion of this form to secure registration. Please send questions regarding billing to amelia@clement-arts.org.

Your participation helps support foster and adoptive families in our community. Thank you!

Parent/Guardian Information

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *

Student Information

Please supply information for each student you'd like to register. You can register up to three students for Clement Martial Arts on this form. Please fill out an additional registration form if you are registering more than three students.

Student Information #1

First Name *
Last Name *
Month
/
Day
/
Year
Child is registering for the following classes (check all that apply)

Does your child have prior martial arts experience? Describe briefly.

Please select your student's uniform size.
Please reference the image at the bottom of this form.
Please select your student's belt size.
Please reference the image at the bottom of this form.
Child in Foster Care?

Does your child have any known allergies or dietary restrictions?

Does your child have any known learning or behavioral diagnosis? This information is kept confidential and only used to help us better serve and instruct your child.

Student Information #2

First Name
Last Name
Month
/
Day
/
Year
Child is registering for the following classes (check all that apply)

Does your child have prior martial arts experience? Describe briefly.

Please select your student's uniform size.
Please reference the image at the bottom of this form.
Please select your student's belt size.
Please reference the image at the bottom of this form.
Child in Foster Care?

Does your child have any known allergies or dietary restrictions?

Does your child have any known learning or behavioral diagnosis? This information is kept confidential and only used to help us better serve and instruct your child.

Student Information #3

First Name
Last Name
Month
/
Day
/
Year
Child is registering for the following classes (check all that apply):

Does your child have prior martial arts experience? Describe briefly.

Please select your student's uniform size.
Please reference the image at the bottom of this form.
Please select your student's belt size.
Please reference the image at the bottom of this form.
Child in Foster Care?

Does your child have any known allergies or dietary restrictions?

Does your child have any known learning or behavioral diagnosis? This information is kept confidential and only used to help us better serve and instruct your child.

Terms & Conditions

I confirm that I am the legal guardian of the child(ren) being registered on this form, and I have chosen to have my child(ren) participate in fine arts instruction given by Clement Arts. I acknowledge that I understand the nature of the activities my child(ren) will be participating in and the possibility that despite precautions, accidents and/or physical injury may occur.

I/we agree to release and hold harmless Clement Arts, including its instructors and staff members from any cause of action, claims, or demands now and in the future. I/we will not hold any of the above liable for any personal injury or any personal property damage or loss which may occur on the premises before, during, or after classes or which may occur at any Clement Arts sponsored event outside the studio.

Furthermore, I/we agree to take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Clement Arts.

I/we authorize and agree that Clement Arts may take and use photographs, videos, or likenesses of myself or my child(ren) as needed for its record keeping, advertising, social media, and/or public relations projects, and that I have no rights to the same and will not be compensated for the same. Clement Arts understands the sensitivities surrounding the photography of children in foster care and will not capture and use any identifiable photographs, videos, or likenesses of children in foster care for any purpose or reason.

Clement Arts will record and analyze program-related data for the purposes of seeking grants to support the ministry of Clement Classes and to improve the positive impact of our classes. Surveys measuring self-esteem will be distributed to all students at the beginning and end of each semester. Instructors will complete assessments at the beginning and end of each semester measuring attainable skill-based goals specific to their classes. Survey data will be used collectively and not based on individual students; only first and last initials will be used to track data. No collected data will be made available to any parent, guardian, or student.

I/we agree for my child(ren) to participate in the above data collection for the purpose of improving the Clement Arts program’s services to children and families.

Waiver Consent

Connections

How did you hear about Clement Classes? Check all that apply.

Please let us know where you actively attend church. If nowhere, please put none.

Would you like to stay informed of Clement Arts news and events through our monthly email newsletter?

Billing Information

(An invoice for classes will be sent to you in January. Please allow time for invoice to be sent.)

Billing Options
Is your child taking more than one class with Clement Classes or do you have more than one child signed up for Clement Classes?
Multi-class discount applies to additional child(ren) or if your child is taking more than one Clement Class.
Is your family active duty military? (10% discount)

Were you referred by a friend or family to Clement Classes? If yes, please include their first and last name below. If no, please type "none".

Payment Info

Registration fee must be paid upon completion of this form to secure registration.

Credit Card Information

cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

Your total payment will be
Your credit balance will cover
Your credit card will be charged
Your bank account will be charged
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