[Silvera Karate Jitsu] New user account

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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: 132132

Full Name: test

Birth Date: 2025/01/06

Gender: Male

Phone Number: 132132

E-mail Address: 132132@fasd.com

Full Address: 132132

Emergency Contact Name: 132132

Relationship to Student: 132132

Emergency Contact Phone: 132132

Do you have prior Karate experience?: Yes

If yes, please specify your belt level and years of experience: 132132

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

If yes, please specify: 132132

Read Terms and Conditions: Yes

Printed Full Name (as your digital signature): 132132

Thank you!