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Dedham Health & Athletic Complex 200 Providence Highway Dedham, MA 02026
781.326.2900 Email [email protected] and [email protected] www.dedhamhealth.com
UNLIMITED MARTIAL ARTS MEMBERSHIP!
A better value One-time registration* Improved student development Flexibility to meet you and your family’s needs Family discounts available
Unlimited Classes (Monthly*)
DHAC Members - $99
Non-Members - $119
Attend as many classes as you can for your age and belt rank!
See attached schedule!
*monthly EFT
DHAC KENPO KARATE CALENDAR 2016-2017 *DATES ARE SUBJECT TO CHANGE*
Sunday, September 11th Back to the Mats!
Wednesday, November 23rd- Sunday, November 27th Closed for Thanksgiving
Friday, December 23rd- Sunday, December 25th Closed for Christmas
Sunday, February 19th-Saturday, February 25th Closed for Winter Break
Sunday, March 19th- Saturday, March 25th Closed for Spring Break
Saturday, April 1st (Tentative Date) 10th Annual Kenpo Karate Tournament
Sunday, April 16th Closed for Easter
Sunday, July 2nd- Saturday July 8th Closed for July 4th Week
Sunday, September 3rd- Saturday, September 9th Closed for Labor Day Week
Dedham Health & Athletic Complex 200 Providence Highway Dedham, MA 02026 781.326.2900 Email [email protected] and [email protected] www.dedhamhealth.com
Keep your eyes open for future announcements about Family Nights, Seminars, and other Special Events!
DHAC KENPO KARATE SCHEDULE
What Classes May I Attend?
*Please make sure you attend the appropriate class for your age and belt rank. You may attend another class only with the express permission of Mr. C. or Miss Cynthia for that day.*
4-6 yrs. old white/yellow belts Little Dragons
4-6 yrs. old yellow/orange belts Little Dragons Intermediate
7-13 yrs. old white/yellow/orange/purple (9 yrs. & younger) belts Youth
7-13 yrs. old orange/purple/blue belts Youth Intermediate
10-15 yrs. old purple (10 yrs. & older)/blue/green/brown belts Youth Advanced
12-17 yrs. old all belt ranks Teen
16+ yrs. old all belt ranks Adult
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
CLOSED Adult
8:00-9:00AM
Little Dragons 9:00-9:45AM
Little Dragons Intermediate 9:00-9:45AM
Little Dragons Intermediate
10:00-10:45AM
Little Dragons 10:00-10:45AM
Youth 11:00-11:45AM
Youth
Intermediate 11:00-11:45 AM
Youth Advanced 12:00-12:45PM
Youth 11:45AM-12:30PM
Adult Open Mat 1:00-2:00PM
Teen 1:00-2:00PM
Little Dragons 2:30-3:15PM
Teen
4:15-5:15PM
Little Dragons 4:00-4:45PM
Youth Intermediate 4:00-4:45PM
Little Dragons 4:00-4:45PM
Youth
5:15-6:00PM Youth
5:00-5:45PM
Little Dragons Intermediate 5:00-5:45PM
*Time Change*
Youth 5:00-5:45PM
Youth
Intermediate 6:15-7:00PM
Adult 6:00-7:00PM
Youth Advanced 6:00-6:45PM
*Time Change*
Adult 6:00-7:00PM
Adult Fight Fitness
7:00-8:00PM *NEW*
DHAC KENPO KARATE MEMBERSHIP REGISTRATION
Dedham Health & Athletic Complex 200 Providence Highway Dedham, MA 02026 781.326.2900 Email [email protected] and [email protected] www.dedhamhealth.com
Account #____________________
Participant Name(s): Age(s):
Parent’s Name(s) (if under 18):
Address: Town: State: Zip Code:
Phone Number: ( ) Email:
Are you a DHAC member? (Circle one) YES NO
Emergency Contact (name and relationship): Phone Number: ( )
Does the participant have any known past or current medical concerns that limit participation in physical activity and contact karate? If yes, please
give detailed explanation.
I have filled out this form to the best of my knowledge and agree to inform DHAC in writing of any changes of health status of participant.
Any dispute, controversy or claim arising under, out of, or relating in any way to this contract and any subsequent amendments of this contract, its formation, validity, binding effect, interpretation, performance, breach or
termination, as well as non-contractual claims, shall be referred to and finally determined by arbitration in accordance with the rules of the American Arbitration Association, and not by court action. Member hereby waives
any and all rights to a jury trial with respect to any dispute, controversy or claim.
SIGNATURE: DATE: / /
(Parent if under 18) # __________ Student 1 __________________________ D.O.B ______/______/______ Monthly: # __________ Student 2 __________________________ D.O.B ______/______/______ Monthly: # __________ Student 3 __________________________ D.O.B ______/______/______ Monthly: # __________ Student 4 __________________________ D.O.B ______/______/______ Monthly: Total:
Monthly Payments
Individual
UNLIMITED
2 Person Family Unlimited
3 Person Family Unlimited
4 Person Family
Unlimited
DHAC Members $99 $193 $282 $366
Non-Members $119 $232 $339 $440
**Attend as many classes as you can for your appropriate age and belt rank**
Dues and Termination Policy All Kenpo memberships are month to month with automatic renewal. Kenpo privileges may be suspended if your dues are in arrears. All members
are required to fill out a termination form personally at the club and have it signed by a manager or mailed to the accounting office by certified mail when terminating their membership with DHAC Kenpo Karate. This notice of termination must be received 30 days prior to the effective date of membership termination, or your monthly charges will continue.
DHAC will notify all members of any changes in club policy by posting such changes 45 days in advance.
Signature (Parent if under 18) ___________________________________________ Date: _______/_________/________
EFT AUTHORIZATION FORM I authorize my bank to make payment directly to DHAC and post it to my account. I am aware that it is my responsibility to keep this information current and that if the above account cannot be accessed for any reason, I will be charged a $25.00 return fee. EFT changes must be made by the 15h of the month, prior to when fees are due, in order to avoid the $25.00 fee. In order to avoid possible kickbacks, DHAC will advance credit card expiration dates when necessary. Visa M/C Amex Checking Acct. (attach check) 1st transfer will be on ______/25th /_______ Account #: ____/____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____ Expiration Date: _______/_______/________ CVV: ______________ Signature: _________________________________________ Date: ______________________________