Application Form

CHARLOTTETOWN & CENTRAL QUEENS
CHITO-RYU KARATE CLUBS

MEMBERSHIP APPLICATION

(1) Complete the sections below, (2) Print the page, and (3) Submit with your membership dues.

Date:

Name:

Age (years):

Male

Female

Mailing Address 1:

Phone:

Medical Condition /allergies 1:

Youth (6-15 years)

Session joining:

Fall (Sep-Dec)

Winter (Jan-May)

Signature
Parent or Guardian
(if under 18):

(1) Complete the sections above, (2) Print the page, and (3) Submit with your membership dues.

To see COSTS for membership, check the DOJOs page (Click)