Registration Form

Student Name:

Phone:

Address:

Email Address:

Age:

Day Attending:

Month:

Date: Time:

Previous Experience:

Special Conditions:

Please review the schedule for appropriate class times by clicking here.

We, the student and guarantor, if applicable, on behalf of ourselves, members of our family, our heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless, Satori Martial Arts and Healing Center of Whitehouse, representatives and agents for any injury, loss, or damage to my person or property howsoever caused, arising out of or in connection with my taking part in martial arts classes and other fitness activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Satori Martial Arts and Healing Center of Whitehouse Representatives or Agents.