Birthday Party Inquiry Birthday Inquiry Students Name * First & Last Parent/Guardians Name * First & Last Students Birthday * Email Address * Enter Email Mobile Phone * Address * Address Street Street Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Your desired date? If you haven't reached out prior to confirm a date this section does not guarantee your preferred date * Down Payment $379 * I Agree The purchaser agrees to pay to Encinitas Karate Inc. or its assignees, a total of $379 for up to 25 kids and an hour and a half Birthday party. I would like to add board breaking $3/child ( input quantity) Credit Card (no amex) Credit Card (no amex) Credit Card (no amex) Credit Card (no amex) Month 123456789101112 Credit Card (no amex) Year 20242025202620272028202920302031203220332034 Credit Card (no amex) Waiver Section Pt. 1 * I Agree I acknowledge tuition payments are based on an annual tuition amount that is broken up into 12 equal monthly payments regardless of whether a month has 5 or 4 weeks. Encinitas Karate Inc. operates on a 12 month, 48 week billing system. Encinitas Karate cannot refund any dues paid by reason of my absence, holiday closures or withdrawal from the course. Month to Month: I hereby agree to purchase a month-to-month term contract membership. I understand that my membership is non-refundable and that Encinitas Karate cannot refund any dues paid by reason of my absence, holiday closures or withdrawal from the course. Buyer may cancel this agreement at any time with 30 days prior written notification. I acknowledge that absences of less than 1 month are not eligible for freezing or credits. A membership cannot be frozen without a freeze agreement form signed 30 days in advance.I acknowledge annually on January 1st membership will increase 3%. Waiver Section Pt. 2 * I Agree I, the applicant/undersigned, do hereby agree to indemnify and hold harmless Encinitas Karate Inc., its instructors, officers, directors, volunteers, officials, staff and contractors from any and al liability, losses or damages whatsoever, including emotional distress, arising from participation in any of their classes, programs and events. In case of accident or other emergency, instructors, officers, directors, volunteers, officials and staff of Encinitas Karate, Inc. are hereby authorized to secure medical care deemed necessary as a result of accident or injury for the participant. I further agree to pay any and all costs incurred as a result of this treatment. The Student/Parent/Guardian hereby represents that he/she has no knowledge of a physical/mental condition, which would render him/her unable to participate in martial arts training activities. Student further represents and promises that in the event that he/she becomes physically or mentally unable to participate therein, he/she will immediately notify Encinitas Karate in writing. Student/Parent/Guardian understands that during the course of instruction, employees or the school and/or other students or authorized persons will be engaged in a course of conduct requiring physical contact and he/she gives full consent to such contact as required by the training. Student/Parent/Guardian recognizes that regular class attendance is important for student progress and understands that it is the student's responsibility to attend classes. It is further understood that the student is obligated to make payments whether or not the student attends classes. Student/Parent/Guardian authorizes Encinitas Karate, Inc. permission to reproduce, publish, circulate, copyright or otherwise use any photographs and/or videotape of student taken at the studio or events anytime without compensation. Student/Parent/Guardian t recognizes that regular class attendance is important for student progress and understands that it is the student's responsibility to attend classes. It is further understood that the student is obligated to make payments whether or not the student attends classes. Signature * signature keyboard Clear Purchaser's/ Guardian's signature Register If you are human, leave this field blank.