Name *

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Date of Birth *

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Address *

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Have you ever training in Martial Arts before? *

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What are your personal goals with your training? *

Please check all that apply

Attention Span

Coordination

Emotional Discpline

Forming Healthy Habits

Mental Discipline

Perseverance

Personal Fulfilment

Physical Discipline

Physical Fitness

Positive Attitude

Self-Confidence

Self-Defense

Self-Image Development

Stress Relief

Weight Loss

*

I hereby agree to the Waiver terms (Look at the bottom of the page for details).