Registration + Waiver

Central Kyokushin Karate/Ultimate Truth LLC

Contact Information

2060 Vantage Hwy Suite 11

Ellensburg, WA, 98926, USA
ultimatetruthllc.com

[email protected]
509-607-9496

Instructions

Please read all sections carefully before completing this form.

Parent/Guardian

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Address *

Street Address

City

State

Postal Code

Sex *

Female

Male

Non-binary

Other

Student Age *

Minor (under 18 years of age)

Adult (18+ years of age)

Relationship to Minor

Mother

Father

Legal Guardian

Court-Appointed Guardian

Other

I certify that I am the legal parent or guardian of the minor student and have full authority to execute this Agreement on their behalf.

Yes

How many students are you registering?

1 Student

2 Students

3 Students

4 Students

Dependant / Child #1

First Name

Last Name

Email

Phone

Date of Birth

Dependant / Child #2

First Name

Last Name

Email

Phone

Date of Birth

Dependant / Child #3

First Name

Last Name

Email

Phone

Date of Birth

Dependant / Child #4

First Name

Last Name

Email

Phone

Date of Birth

Martial Arts Background and Goals

These questions help us better support your training goals.

What is your main goal for exploring martial arts training? *

How much time and energy do you typically invest in learning new skills? *

How did you discover Central Kyokushin Karate?

Please indicate your level of prior martial arts experience:

No formal training

Introductory or short-term experience

Foundational training (consistent but under 1 year)

Developed training (1–3 years, possibly ranked)

Extensive training (3+ years and/or advanced rank, police, military)

Medical Disclosure

Are there any pre-existing medical conditions, injuries, or health concerns that may affect safe participation in martial arts training? *

No

Yes

Please check all that apply.

Asthma or other respiratory conditions

Seizures, epilepsy, or neurological conditions

Heart condition, cardiac history, or high blood pressure

Diabetes or blood sugar regulation issues

Pregnancy

Current use of prescription medication that may affect physical activity

Prior or current joint or muscle injuries (e.g. back, knees, neck, etc.)

Recent surgery or medical procedure

Any other medical condition that may affect safe participation

Do you know of ANY OTHER REASON that would INHIBIT your physical activity or martial arts training? *

No

Yes