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Vickery After School Karate (ASK) Registration

All fields marked with (*) are required.
Parent/Guardian Information
Parent Name Required!
Parent Name Required!
Email Required!
Phone Required!
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Address Required!
Address Required!
City Required!
ZIP Required!
How Many After School Students?
You MUST select the number of campers to register!
ASK Student 1 Info
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You MUST select a school!
You Must Select at Least One Camp!
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ASK Student 2 Information
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You MUST select a school!
You Must Select at Least One Camp!
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ASK Student 3 Information
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You MUST select a school!
You Must Select at Least One Camp!
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ASK Student 4 Information
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You MUST select a school!
You Must Select at Least One Camp!
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You Must Enter at Least One Emergency Contact Name!
You Must Enter at Least One Emergency Contact Phone!
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You Must Enter at Least One Person Permitted to Pick Up!
REGISTRATION FEE(S): A registration fee is required for each student/child.

Existing/Returning Member Fee (includes new uniform):
Sign up on/before April 30: $35
Sign up May 1-31: $50
Sign up on/after June 1: $100

New Member Fee (includes starter kit - uniform bag & gloves):
Sign up on/before April 30: $75
Sign up May 1-31: $100
Sign up on/after June 1: $150

If you're not already a member or wish to use a different payment method, after submitting this form you will receive email instructions on how to pay your deposit in order to finalize your registration and reserve your spot(s).
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You must check this box!
You MUST agree to the Terms & Conditions!
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