REGISTER FOR THE FALL TRIMESTER
Mondays, 8:00 am – 8:55 am, in the gym
OCTOBER 1, 2012 to DECEMBER 10, 2012
Grandmaster Connelly has provided safe, fun and, on many
levels, rewarding experiences for young martial artists in District
65 since 1993. Every class is guided by the traditional Taekwon-
do values of respect, responsibility and commitment to lifelong
learning. Students receive expert instruction building focus, self-
discipline and leadership for success both inside and outside of
The Taekwon-do class is sponsored by the Orrington PTA and Kidpower Chicago, a nonprofit organization with over
20 years of experience providing programs that empower young people to stay safe and believe in themselves.
The program is open to all students, K through 5 grade. If your child would like to participate in the class:
Register on-line before Friday, September 14th. Visit www.connellysacademy.com and follow the link on the
bottom right for On-Line Registrations. Scholarship requests are not available on-line.
Please deliver forms and payment (or write SCHOLARSHIP on your form) to your child’s teacher or to the PTA
mailbox by Friday, September 14th.
NOTE: Scholarships are available through the PTA. If you need a scholarship, please write SCHOLARSHIP on
Uniforms are optional for beginners and available for $35. Belt promotion opportunities – where kids can advance in
rank level and earn a higher belt color by demonstrating what they have learned – are offered several times a year at
McGaw YMCA and the Levy Center for $30. Additional youth and adult classes are available at several community
service locations. For more information about classes, curriculum support and refund policy, go to
...............................................Please Return the Bottom Portion of the Form with Your Check or Money Order.......................................................
Please Register (Student) _______________________________________ for the Taekwon-Do Club.
Homeroom Teacher _______________________ Grade ______________
“I consent to my child’s participation in the Taekwon-do Club at Orrington School. I acknowledge that participation in the
Taekwon-do Club includes inherent risks. I expressly assume the risk of any and all injuries (including death), illness, or
damage to property and loss that may result from my child’s participation in the Taekwon-do Club activities. I hereby
voluntarily release and discharge Kidpower Chicago, Connelly’s Academy, Inc. and District 65 its agents and employees
from any and all claims for injury (including death), illness, damage to property or loss which my child may suffer as a
result of his/her participation in the Taekwon-do Club. I understand that School District 65 is not a sponsor of the
Taekwon-do Club. I have read and fully understand the above program details and participation agreement."
Parent/Guardian Signature Parent/Guardian Printed Name
Date __________________ Day Phone ________________ Evening Phone ________________
E-Mail __________________________________________________ Cell Phone____________________
*Amount Enclosed: Full Tuition $110 ck#______________
*Returned checks will be subject to a $25 fee and e-collection processing. 2012FallOrrington