Enrollment Agreement

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Member name 1 *

First Name

Last Name

DOB

MM

DD

YYYY

Member Name 2

First Name

Last Name

DOB

MM

DD

YYYY

Member name 3

First Name

Last Name

DOB

MM

DD

YYYY

Please read: *

BILLING AGREEMENT: This agreement is between the customer and Xcel Taekwondo Center in relation to business. Monthly payments will be processed on the first of every month. Any account more than 5 days past due will incur a $15 late fee. Xcel Taekwondo Center is not responsible for any credit card fees incurred by the customer. Xcel Taekwondo Center has the sole right to modify any payment due date and to resubmit returned or declined items without prior notice. If you wish to cancel this agreement, you must do so in writing and all cancellations require a 30 day notice. Xcel Taekwondo Center will not be responsible for any refunds. Credits can be applied to future programs or fees at Xcel Taekwondo Center only. Release and Waiver of Liability We, the student and guarantor, if applicable, on behalf of ourselves, members of our family, our heirs, executors, administrators and assignors, hereby forever release, discharge and hold harmless, Xcel Taekwondo Center, 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 activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Xcel Taekwondo Center representatives or agents.

Agree

Disagree