Wilde Lake Karate Registration Before- After School 2021-22
(Must Fill out for each Child)

We Ask for identification card of this person each time pick up your child
Our Programs are not designed for students who have Physical and psychiatric challenges.
Any health Problem or medication use?Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? if Yes Please Explain. Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s Before & After School experience is positive? if Yes Please Explain. (Must Answer Yes or No)*
Any health Problem or medication use?Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? if Yes Please Explain. Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s Before & After School experience is positive? if Yes Please Explain. (Must Answer Yes or No)*
(Full time Monday to Friday) (Part Time any set 3 days a week)
Please let us know of any requests,