Afterschool Enrollment Form - Oliver Martial Arts Academy

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Program Hours & Policies

Program Hours & Late Pick-Up

Please review our program hours based on school type:

Hillsborough County Schools: 1:55 PM – 6:30 PM
Private / Charter Schools: If your child(ren) attend a Private/Charter school, please enter their school release/pick-up time: PM – 6:30 PM

                            Latest pick-up time: 6:30 PM.

                            Late fee after 6:30 PM: $1.00 per minute (NO EXCEPTIONS).

I acknowledge OMA program hours and late fees (Initials) *

Liability Waiver & Release

ASSUMPTION OF RISK & RELEASE OF LIABILITY

PLEASE READ CAREFULLY

I understand that participation in transportation services, martial arts training, and related activities involves inherent risks, including but not limited to injury, illness, property damage, exposure to communicable diseases (including COVID-19), or death.

To the fullest extent permitted by Florida law, I hereby release, waive, and forever discharge Oliver Martial Arts Academy – Riverview, Corp., its owners, officers, instructors, employees, agents, drivers, and representatives (“Providers”) from any and all claims, including those arising from negligence, connected to my Student's participation in the After-School Karate Transportation Program.

I agree to the Liability Waiver & Release (Initials) *

Parent/Guardian Signature *

Sign here with mouse or finger

Health, Safety & Program Acknowledgments

Hand Sanitizer & Hygiene

Hand sanitizer will be provided, and handwashing will be encouraged.

Initials *

Photo / Video Release

Photos and/or videos may be taken during program activities and used for promotional purposes.

Initials *

Program Status

This program is not a daycare, tutorial, or school extension.

Initials *

Transportation & Karate Class

OMA provides weekday transportation from the student's school to the academy for one (1) hour of karate training per day, Monday–Friday during the school year.

Initials *

Student Pick-Up Protocol

Parents/guardians must enter the academy to pick up students.

Initials *

Medical Information

Medical Policies

Illness & Pickup Policy

If a student becomes ill or has a temperature of 100.0°F or higher, parents agree to pick up the child within 30 minutes.

Initials *

Emergency Authorization

In case of emergency, I authorize medical treatment if I cannot be reached.

Initials *

Health & Vital Details

Insurance Provider *

Group / Policy # *

Medications *

Allergies *

Food Restrictions *

Medical Conditions *

Physician & Phone *

Preferred Hospital *

Parent / Guardian Information

Parent / Guardian Contact

Parent Work Phone

Extension

Mom Cell Phone *

Dad Cell Phone *

Home Address *

City *

ZIP Code *

Email Address *

Authorized Pick-Up Persons

AUTHORIZED PICK-UP PERSONS

The following individuals are authorized to pick up my child(ren). Valid photo ID is required for verification:

Authorized Person #1

Full Name *

Relationship *

Phone *

Emergency Contact? *

Yes No

Authorized Person #2 (Optional)

Full Name

Relationship

Phone

Emergency Contact?

Yes No

Authorized Person #3 (Optional)

Full Name

Relationship

Phone

Emergency Contact?

Yes No

Tuition Policies & Cost Summary

PAYMENT & ATTENDANCE POLICIES

NO DAILY FEES / NO REFUNDS

Absences Fee

Absences due to vacation, illness, COVID, or non-school calendar closures do not hold seats. A $45 weekly fee applies during absences.

Initials *

Advance Payments

If no automated payment is provided, one-week advance payment is required.

Initials *

Weekly Fees & Late Fees

Weekly fees are due on Friday before the service week (no later than Monday). Late fees: Tuesday: $10, Wednesday: $20, Thursday: $30, Friday: $40 per child.

Initials *

Personal Checks

Personal checks are not accepted. Payments may be made by phone.

Initials *

Withdrawals & Non-attendance

Due to limited transportation seating, NO REFUNDS for withdrawal or non-attendance.

Initials *

Missed Payments Notice

Failure to notify OMA of absences or missed payments results in automatic withdrawal.

Initials *

Absences Reporting

Absences must be reported by phone 813-278-8551 or TEXT 813-897-3476.

Initials *

Safety & Program Acknowledgments

Student Health

Student participation is voluntary and at the parent's permission. Students are in good health.

Initials *

Belt Testing

Belt testing may be offered every 3–4 months for an additional fee (optional).

Initials *

Communication

All program communication must come from the parent or approved guardian.

Initials *

School Lockdown Protocol

In case of school lockdown/lockout, OMA drivers will follow safety protocols and parents will be contacted to pick up students directly from the school.

Initials *

Program Fees & Tuition Details

Registration (New Students): $110 (Includes Uniform, belt, bag, car magnet, association fees)
Registration (Returning Students): $50 per child
Weekly Fee: $85 for First Child | $75 for Sibling / Additional Children

I acknowledge OMA pricing list (Initials) *

Payment Choice & Estimated Total

Select how you plan to make After-school payments:

Cash

Please bring cash payment to the OMA office.

Credit Card / Debit Card (Recurring)

Generate billing authorization to complete in-person.

Tuition Cost Summary

Weekly Tuition Fee $85.00

Total One-Time Registration Fee $110.00

Credit Card Recurring Payment Authorization

Recurring Payment Authorization Form

Here's How Recurring Payments Work: You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 3 days prior to the payment being collected.

Billing Authorization Agreement:

I authorize Oliver Martial Arts Academy – Riverview, Corp to charge my credit card indicated below for the designated weekly tuition fee on each MONDAY of each WEEK while I am using the After-School Transportation & Karate Services, starting at the date this form is signed.

Cardholder Billing Information

Billing Address *

City, State, Zip *

Work Phone

Cell Phone *

Billing Email Address *

Credit Card Details (To fill in-person)

Note: For security, do not enter credit card digits online. Please select the card type and cardholder name below. You will fill out card numbers manually in-person at the OMA office.

Card Type *

Visa MasterCard Amex Discover

Cardholder Name *

Card Number

I understand the charges agreed will take effect in full regardless of student participation. I agree to notify OMA in writing of changes 15 days prior. Early cancellation triggers a $100 administrative charge. Returned payments are subject to a $30 charge.

Cardholder Authorization Signature *

Sign here with mouse or finger

Review Your Information

Please review your information below. Use the Edit buttons to return to any section and make corrections before submitting.

Acknowledgment & Final Signature

Acknowledgment & Signature

I certify that I have read, understand, and agree to all terms and conditions of this enrollment form.

Mother's Name (Print)

Father's Name (Print)

Parent/Guardian Signature *

Sign here with mouse or finger

Date *

I confirm that I have read and agree to all policies, waivers, and terms in this registration form. I understand that all payments are non-refundable and that I am responsible for following all OMA After-School rules and guidelines.

You’re Registered!

Registration submitted successfully.

✉

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Confirmation Number —

Thank you for enrolling in the
OMA After-School Karate & Transportation Program 2026–2027.

We look forward to seeing your child(ren) this school year! 🥋

📞

Call or Text
(813) 278-8551

🌐

Website
www.omakarate.com

📍

Location
Oliver Martial Arts Academy – Riverview

If you have additional questions, please don’t hesitate to contact the academy. We’re happy to help!

Oliver Martial Arts Academy – Riverview

Student's enrollment form

General Details

After-School Pick-Up Days *

Program Hours & Late Pick-Up

ASSUMPTION OF RISK & RELEASE OF LIABILITY

Health, Safety & Program Acknowledgments

Hand Sanitizer & Hygiene

Photo / Video Release

Program Status

Transportation & Karate Class

Student Pick-Up Protocol

Medical Policies

Illness & Pickup Policy

Emergency Authorization

Health & Vital Details

Parent / Guardian Contact

AUTHORIZED PICK-UP PERSONS

Authorized Person #1

Authorized Person #2 (Optional)

Authorized Person #3 (Optional)

PAYMENT & ATTENDANCE POLICIES

Absences Fee

Advance Payments

Weekly Fees & Late Fees

Personal Checks

Withdrawals & Non-attendance

Missed Payments Notice

Absences Reporting

Safety & Program Acknowledgments

Student Health

Belt Testing

Communication

School Lockdown Protocol

Program Fees & Tuition Details

Payment Choice & Estimated Total

Recurring Payment Authorization Form

Cardholder Billing Information

Credit Card Details (To fill in-person)

Acknowledgment & Signature

You’re Registered!

Oliver Martial Arts Academy

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