DSA Taekwondo Registration

DSA Taekwon-do Membership Registration

Please complete the form below to sign up for membership. Upon submission and signing this shall constitute an agreement between DS Andaya Enterprises Ltd DBA DSA ROYAL INTERNATIONAL TAEKWON‐DO, (herein after called DSATKD) and the student (or if under legal age represented by parent or guardian whose information is listed below), herein after called MEMBER.
Student Name*

First NameMiddle NameLast NameSuffix
Training Start Date:*

MonthDayYear
Date
E-mail*
Phone Number:*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Address:*

Street Address

City, Province, Postal Code

CityState / Province

Postal / Zip Code
Birth Date:*

MonthDayYear
Age*
Program to register

Taekwon-DoArnis/Kali/Filipino Martial ArtsOther
Are you enrolling through one of our affiliate programs ?*

DSRFNoWonderworldOther
Where did you hear about us?

A FriendGoogleFacebookNews ArticleOther
Any Medical or Physical Condition that may affect performance? i.e. Special Needs, asthma, etc.*
Parents/Guardian Information

If the student is a minor, provide this information
Parent 1*

First NameLast Name
Parent 1 Email*
example@example.com
Parent 1 Cell*

Area CodePhone Number
Parent 1 Relation to Student*
Parent 2

First NameLast Name
Parent 2 Email
example@example.com
Parent 2 Cell

Area CodePhone Number
Parent 2 Relation to Student
Child primarily lives with

Both ParentsFatherMotherLegal GuardianOther
If a custody order or any other legal document governing the custody or guardianship of your child exists, a copy of the most recent custody document must be placed in the student's record.
Name of Current Legal Document
Date of Current legal document

MonthDayYear
Date
Upload custody document

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Person Signing This form*
Date/Time Submitted*
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DSA Taekwon-do Membership Registration

Parents/Guardian Information