Tae Kwon Do Student Application
Name (Please Print Clearly) Today's Date
City State Zip Code
_______________________ ____ _________________________
Phone Number Age E-mail Address
Parents (if under 18):___________________ _____________________
I, the undersigned, understand that Tae Kwon Do is a contact sport and that I may be injured. I will not hold Kevin Grell, the Shiloh Lutheran Church or any member of the Club responsible for any injuries I may sustain.
Student's Signature Parent (if student is under 18)