Fill - Free fillable LJFA STUDENT REGISTRATION FORM PDF form

LJFA STUDENT REGISTRATION FORM

Fencer’s Name: _______________________________________________________________________________________ DOB _________

Parent’s Name: _______________________________________________________________________________________________________

(If fencer is younger than 18)

Phone Number: ___________________________________Email: ____________________________________________________________

Emergency Contact Person: __________________________________________________________________________________________

(name and Telephone Number)

AUTHORIZATION FOR CREDIT CARD PAYMENT

Credit Card number: ______________________________________________________________________________________________________

Expiration date: _______________________ Billing Address ZIP code: _______________________________________________________

Name on the credit card: ___________________________________________________________________________________________________

Authorized signature:

________________________________________________________________________________________________________________________________

Please bill me for the following services:

___________________________________Total Monthly Fee

La Jolla Fencing Academy will charge the above credit card account for the services indicated.

Class package fees are billed monthly. The price for each month is the same regardless of the number of

class days. We do not pro-rate class package fees for missed classes.

Pre-payment and registration for all class packages is required. Payment for each month of class packages

must be received at the beginning of each month before the first class is taken. The tuition of students not starting

at the beginning of the month will be prorated for that month.

La Jolla Fencing Academy must receive a written notification of any changes in enrollment or payment

choices at least one week before the billing date. This can be done by email or by handing the letter off in person at

the academy.

If you are taking classes or lessons at the La Jolla Fencing Academy, you must leave a Credit Card on file.

You are responsible for updating the La Jolla Fencing Academy office with the most up to date credit card

information to continue taking classes at the academy.

If you are unable to attend a private lesson, you must cancel the private lesson 24 hours prior to scheduled

time. If a private lesson is not canceled 24 hours prior to the scheduled time, you will be charged for the full lesson.

La Jolla Fencing Academy reserves the right to terminate the service at any time.

I agree to the above terms and conditions.

________________________________________________ Date: ________________________________

(Signed)

I WOULD LIKE TO REGISTER FOR:

BEGINNER CLASS PACKAGES

FIRST MONTH TRIAL (3) CLASSES Per Week $150 / Month_____

YOUTH 6-7 (Age 6 to 7) MON, WED 4:00-5:30pm & SAT 11:30- 1:00pm