Hickory Tae Kwon Do Club
Tae Kwon Do Student Application

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Name               (Please Print Clearly)        Today's Date


City                                              State                                            Zip Code             

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Phone Number                           Age        E-mail Address

Parents (if under 18):___________________        _____________________
                                               Mother                                  Father

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, St. Luke's United Methodist or any member of the Club responsible for any injuries I may sustain.

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Student's Signature                      Parent (if student is under 18)