[Silvera Karate Jitsu] New user account

Silvera Karate Jitsu

test has just created an account on Silvera Karate Jitsu.

Here is the submitted registration form:

User registered date: 7:37 pm

Form: Default Registration – Form ID#: 1020

Username: test

Full Name: test

Birth Date: 2025/01/06

Gender: Male

Phone Number: 7346585834

E-mail Address: info@silveradokarate.com

Full Address: 38245 Palmateer Rd

Emergency Contact Name: test

Relationship to Student: etes

Emergency Contact Phone: 7344473000

Do you have prior Karate experience?: Yes

If yes, please specify your belt level and years of experience: sfasdf

Do you have any medical conditions or allergies we should be aware of?: No

If yes, please specify: (empty)

Read Terms and Conditions: Yes

Printed Full Name (as your digital signature): Oscar Silvera

Thank you!