Student Pre Check In



 
 
NUMBER OF PERSON TO PRE-CHECK:    
 
I AM A (/WE ARE A):
LOCATION:
 
STUDENT / GUEST #1
FIRST NAME:
LAST NAME:
CLASS:
 
PARENT OR GUARDIAN INFO  
(Type your name if you are an adult)  
Parent/Guardian First Name
Parent/Guardian Last Name
 
CONTACT INFO  
CELL OR HOME PHONE NUMBER:
EMAIL:
 
ARE YOU OR YOUR CHILD EXPERIENCING OR FEELING ANY OF THE FOLLOWING?
If yes to any of the following, you are not allowed to enter the building
 
 
 
 
 
 
 
 
 
Agreement/Acknowledgement
The parent, guardian, and student fully understands and appreciates both the known and potential dangers of utilizing the facilities, services, and programs of Okamoto's School of Karate and acknowledges the use thereof by the undersigned and/or participating children may, despite Okamoto's School of Karate's reasonable efforts to mitigate such dangers, result in the exposure of COVID-19.
By entering the dojo, you also agree to follow the rules, including following the safety guidelines set by Okamoto's School of Karate.