Youth Karate : Youth : Our Programs : Bent County Community Center

Youth Karate ( Instructor Laura Jordan)

Instructor Contact #: 575-420-7747

SPRING SESSION : MARCH-31.2023-APRIL-21.2023

Register below
*Please call the instructor with any questions or concerns about the classes.
Laura Jordan ( Instructor Contact #: 575-420-7747).

BCKC CURRENT Belts:

Toryn Neugebauer = GREEN BELT (2022)

Jordy Smith = ORANGE BELT ( 2022)

Rose Spano= ORANGE BELT ( 2022)

Caleb Dockter= ORANGE/BLACK BELT ( 2022)

Laken Neugebauer=YELLOW/BLACK BELT ( 2022)

James Kermoade= YELLOW/BLACK BELT ( 2022)

Dominique McCullough= YELLOW BELT ( 2022)

Virginia McCullough= YELLOW/BLACK BELT (2022)

Register Here !

Name of Child

( Register One child at a time)

First Name *

Last Name *

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Parent Name/ Guardian

First Name *

Last Name *

Primary Phone number (Required)

Primary Cell #

Email of parent/guardian (Required)

Email of parent/guardian

Emergency Contact Info:

(Not a Parent/ Guardian)

First Name *

Last Name *

Emergency Contact Cell # (Required)

Emergency Contact Cell #

Grade of Participant (Required)

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Current Belt (Required)

Bent County Liability Notification:

Liability Waiver (Required)

PLEASE READ TO SUBMIT (Liability Waiver )

I hereby release and absolve the Bent Count Recreation League, the City of Las Animas, Bent County and all its employees or agents of same from any claims arising from injury received by the participant involved in this activity, whether due to negligent acts or omissions of said parties, other participants or otherwise. In case of accident or illness, I hereby authorize a representative of the BCRL to use his/her judgment in obtaining immediate medical care. I understand that some teams may travel to other towns for games and/or tournaments. I understand that it is my responsibility to provide or arrange transportation for my child(ren) to out of town games.  Participant Obligations: As with any extracurricular activities, education comes first.  All participants must attend a full day of school before participating in any BCRL organized event.      By signing below as parents/guardians/participants, you agree to the above conditions as listed on this form. Failure to comply may result in any or all of the following: suspension of participation in upcoming events, dismissal from the team, or the participant and or family no longer permitted to participate in BCRL sponsored events.  General Participant Waiver Acknowledgement and Waiver of Liability City of Las Animas, Las Animas School District, Bent County and  Bent County Recreation League  Event/Activity:  Bent County Youth Football As a participant in the above named event or activity, I am doing so at my sole risk.  Insurance coverage of any type is not provided by the county, its Board of County commissioners, appointed boards, its employees, its agents or its assigns, regarding any injury, loss of liability that may arise through the participation in this activity. I fully understand and agree that if I use any of my personal property while participating in this event or activity, the county will not provide insurance coverage or be financially responsible should damage or loss occur. By signing this Acknowledgement and Waiver of Liability, I agree to abide by all rules and regulations pertaining to this activity.  I further agree and understand that the county is not responsible for my actions and I release and absolve the county from any liability associated with this event.

Parent/Guardian authorizing

Name of Parent/Guardian authorizing

First Name *

Last Name *

BC Karate Club "TIGERS"

Youth

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