Kids & Teens Krav Maga Registration For The Semester

On Completion/Submission Of This Form You Will Be Redirected To A Secure Payment Form. Please allow 24 hours for enrollment to take effect - you will receive an email confirmation once your enrollment is complete. If you would like a copy of this form please email Liz at: liz.kmy@bostonkravmaga.com.

On completion of this form you will be taken to a secure payment form, where you can make payment for the session option you choose. If you would prefer you can set up a monthly payment plan (a link to request this is provided on the payment form).

Winter/Spring Semester (January - June 2025)
Please Select Your Session:

Please Select Your Session: Saturday (11:15 AM - 12:00 PM) Kids & Teens (6 Years to 17 years) - $270
Name of Child/Teen Participating Name of Child/Teen Participating First Last
Their Preferred Pronouns
Participant's Date of Birth (Participant must be between the ages of 6 and 17) Participant's Date of Birth (Participant must be between the ages of 6 and 17) / MM / DD YYYY
Tee Shirt Size

Tee Shirt Size Youth S Adult S Youth M Adult M Youth L Adult L Youth XL Adult XL
Please Select an Option:

Please Select an Option: My child is a new student, and will need a KMY class shirt in the above size My child has outgrown their KMY class shirt and will need a new one in the above size My child does not need a new shirt at this time
Parent/Guardian Details
Parent/Guardian of Participant Parent/Guardian of Participant Title First Last Suffix
Parent/Guardian Email Address
City Where You Live
State Where You Live e.g. MA
Must be 2 characters. Currently Entered: 0 characters.
Emergency Contact Details

Who We Should Contact In The Event Of An Emergency - You are Giving Permission for this Person to Take Your Child Home from Class.
Emergency Contact Name Emergency Contact Name First Last
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####
What Is The Participant's Relationship With The Emergency Contact?
Additional Emergency Contact Details

If You Would Like To Add An Additional Emergency Contact You Can Do So In This Section (This Is Not Required) - You are Giving Permission for this Person to Take Your Child Home from Class
Additional Emergency Contact Name Additional Emergency Contact Name First Last
Additional Emergency Contact Phone Number Additional Emergency Contact Phone Number - ### - ### ####
What Is The Participant's Relationship With The Additional Emergency Contact?
Youth PARQ

The purpose of this form is to protect your child's health and safety. Please read and complete this form before your child/teen attends their first Krav Maga class in order to discover whether there is any reason why Krav Maga training may not be safe for them.

If you cannot answer "no" to the following questions, it may be unsafe for your child to practice Krav Maga, and they will not be able to attend classes at Krav Maga Yashir Boston.
Has your doctor ever said that your child/teen has a heart condition and that your child/teen should only do physical activity recommended by a doctor?

Has your doctor ever said that your child/teen has a heart condition and that your child/teen should only do physical activity recommended by a doctor? No
Does your child/teen ever experience chest pain during physical activity?

Does your child/teen ever experience chest pain during physical activity? No
Does your child/teen ever lose balance because of dizziness or do they ever lose consciousness?

Does your child/teen ever lose balance because of dizziness or do they ever lose consciousness? No
Does your child/teen have a history of epilepsy or seizures?

Does your child/teen have a history of epilepsy or seizures? No
Does your child have a bone or joint problem that could be made worse by a change in their physical activity participation?

Does your child have a bone or joint problem that could be made worse by a change in their physical activity participation? No
Does your child have uncontrolled asthma (i.e. asthma that is not easily controlled by an inhaler)?

Does your child have uncontrolled asthma (i.e. asthma that is not easily controlled by an inhaler)? No
Is your child/teen pregnant?

Is your child/teen pregnant? No
Do you know of any other reasons why your child/teen should not undergo physical activity and participate in this Krav Maga program?

Do you know of any other reasons why your child/teen should not undergo physical activity and participate in this Krav Maga program? No
Terms & Conditions (Please Read & sign)

In consideration of my child/teen being allowed to attend Krav Maga classes, I acknowledge that Krav Maga is a physical activity and that participation may result in serious injury including death, and or other damage, due not only to my child's actions, inaction or negligence, but also to that of others associated with and or present at these or other classes. Furthermore, I acknowledge that there may be risks not known to me and or not reasonably foreseeable at this time. I personally, totally and completely assume all risks involved or in any way related to my child's participation in this Krav Maga class whether known or unknown to me at the present time. My child's participation in this Krav Maga class is voluntary and entirely of mine and my child's own free will. I hereby represent and certify that my child is in good physical condition, and has no diseases, injuries or other physical or mental conditions that would impair their ability to participate in the Krav Maga class. I, my heirs, executors and successors hereby waive and claim of accidental and or negligent tort damages or injury against Krav Maga Yashir Boston and its instructors. I also certify that my child is covered by a medical insurance plan and if asked I will present the needed information for approval to attend and participate in one of the Krav Maga Yashir Boston classes. Whilst training on the premises of Krav Maga Yashir, and/or at events and seminars organized or arranged by Krav Maga Yashir, I acknowledge that photographs or video may be taken, and I give Krav Maga Yashir permission to use these photographs and video containing my child's image for any and all purposes. By signing below, I guarantee that in accordance with the rules of Krav Maga Yashir, I will not make any recording, in any format: video, audio, or photography, within the Krav Maga Yashir facility. I further understand that by accessing content on the Krav Maga Yashir websites I am agreeing to the Terms & Conditions set forth on those sites.
Please draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my - the parent/guardian's - signature. Clear

Full Name

I understand this is a legal representation of my - the parent/guardian's - signature.
Terms & Conditions Of Enrollment At Krav Maga Yashir (Please Read & Sign)

Krav Maga Yashir Enrollment Terms: Upon completion of this enrollment form and the payment form, your child/teen will be enrolled in the aforementioned session of the Krav Maga Yashir Kids/Teens Program. Your registration payment for this session is non-refundable.

Please bear in mind that the Covid-19 situation is still dynamic, and rules/requirements may be subject to change, as we do our best to safely manage the changing situation. A change to Covid protocols may affect participants as well as accompanying adults. Refunds will not be given due to a change to Covid protocols.
Please draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my - the parent/guardian's - signature. Clear

Full Name

I understand this is a legal representation of my - the parent/guardian's - signature.

Kids & Teens Krav Maga Registration For The Semester

Kids & Teens Krav Maga Registration For The Semester

Winter/Spring Semester (January - June 2025)

Parent/Guardian Details

Emergency Contact Details

Additional Emergency Contact Details

Youth PARQ

Terms & Conditions (Please Read & sign)

Terms & Conditions Of Enrollment At Krav Maga Yashir (Please Read & Sign)