<p> PATASKALA MARTIAL ARTS ACADEMY, LLC</p><p>Student Name: ______AGE:______DOB______</p><p>Address: ______City:______ZIP:______</p><p>Phone Number: ______email address: ______Type of enrollment: Kids (4 to 6 years old) or Youth (7 to 13 years old)</p><p>______Three (3) month ______One (1) year</p><p>My enrollment begins on ______(date) and ends on ______. I agree to the payment schedule set forth below. I understand that enrollment will automatically renew at the end of the term at the same rate as set forth below unless I give thirty (30) calendar days written notice prior to the end of term. </p><p>PAYMENT SCHEDULE:</p><p>Three month enrollment: $60 per month. Payment due on the ______of each month.</p><p>One year enrollment: Eleven months paid in advance in the amount of ______(non-refundable) and one month free. Payment received on ______(date), Enrollment period ending on ______(date).</p><p>PAYMENT METHOD:</p><p>□ check □ credit card: ______EXP:______CVV:______</p><p>CANCELLATION:</p><p>You may cancel this contract for any reason at any time prior to midnight of the third business day after the date you signed this contract. If you cancel within this period you are entitled to a full refund of any money paid. To cancel this contract during this period, you must give written notice of your intent to cancel to Pataskala Martial Arts Academy using the attached Notice of Cancellation form or any other written notice.</p><p>You may cancel this contract if you move your residence more than 25 miles from Pataskala Martial Arts Academy. You may also cancel this contract if you are injured and cannot train for a minimum of 30 consecutive days. You may also cancel this contract if you become unemployed or can demonstrate other financial hardship. If you cancel for any of these reasons you must give thirty (30) days written notice using the attached Notice of Cancellation form. You will be entitled to a pro rated refund of your enrollment fee. </p><p>Pataskala Martial Arts Academy reserves the right to cancel your contract if your enrollment fee is more than ten (10) calendar days overdue. </p><p>Student signature: ______Date: ______</p><p>(Or Signature of parent or guardian if student is under the age of 18)</p>