PHOENIX JKD INSTITUTE

Jeet Kune Do · Filipino Martial Arts (FMA) / Kali · Brazilian Jiu-Jitsu · Athletic Performance — Est. 1988
Registration & Membership Agreement. Please complete every step — your progress is saved as you go, and nothing is submitted until you review and confirm on the final screen.
Step 1 of 6
Your Information
Your Information
Tell us who's joining. If the student is under 18, a parent or legal guardian will need to complete this form on their behalf.
Required.
Required.
Please enter a valid email.
Please enter your street address.
Required.
Required.
Please enter a 5-digit ZIP code.
Please enter a valid 10-digit phone number.
Please select your date of birth.
Parent / Guardian
A parent or legal guardian must complete, sign, and be present for all registration and waiver terms on the minor's behalf.
Required for minors.
Required for minors.
Emergency contact *
Required.
Please enter a valid 10-digit phone number.
Program(s) I am enrolling in *
Please select at least one program.
Client / Student signature *
By signing, you certify the information you entered above in Section 1 is true and accurate.
Sign above with your finger or mouse
Please provide your signature.
Assumption of Risk, Waiver & Release of Liability
Client / Student signature *
Confirms Sections 1 and 2 have been read and agreed to
Please provide your signature.
Signature of Parent / Legal Guardian *
Required if student is under 18
Parent / guardian signature required for minors.
Membership, Tuition & Fees
Cancellation & Early Termination
You must agree to continue.
Social Media & Photo / Video Release
Please select an option.
Membership Plan Selection *
Please select one:
Please select a plan.
Recurring Payment Authorization
I authorize Phoenix JKD Institute, LLC to charge the card on file below for the total monthly payment of my dues, on the billing date I select, until this authorization is cancelled in writing.
Security note: Your card details are entered into a secure form provided by Square, our PCI-compliant payment processor. Your card is transmitted directly to Square over an encrypted SSL / TLS connection and never touches this website's database or servers.
Card details *
Please enter valid card details.
Name on card *
Required.
Plan
No plan selected
Please select a plan above.
Billing date *
 
Please select a billing date.
You must agree to authorize recurring payments.
Review & Final Signature
Please review your information below. By signing at the bottom, you certify that you have read this entire Agreement (Sections 1 through 8), that you understand it includes a waiver of legal rights, membership and payment terms, a limited cancellation policy, and a media release, and that you are signing it voluntarily.
Required.
Final signature — Client / Student (if 18 or older) *
Required unless the student is a minor
Signature required.
Final signature — Parent / Legal Guardian *
Required if student is under 18
Parent / guardian signature required for minors.

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