Mozhdeh Martial Arts Free Trial Form

Mozhdeh Martial Arts - NZ

Sign-up form for free trial of Taekwondo classes
How many people do you wish to sign-up for a free trial?*

OneTwoThree or more
Athlete Information
Athlete’s name*

First NameLast Name
Birth date*

DayMonthYear
Which class/es would you like to try? The free trial week includes unlimited classes within the same week. *
Second Athlete Information
2nd Athlete’s Name

First NameLast Name
2nd Athlete’s Birth date

DayMonthYear
Third Athlete Information
3rd Athlete’s Name

First NameLast Name
3rd Athlete’s Birth date

DayMonthYear
Any medical conditions or allergies?
Contact details (for parent/guardian if under 18)
Mobile Number*

eg 021Phone Number
Name of parent / guardian if athlete is under 18

First NameLast Name
Acknowledgement

All sports carry a risk of injury and that Mozhdeh Martial Arts is not responsible for injuries or loss suffered as the result of participating in these activities. In the event of an injury or medical emergency, Mozhdeh Martial Arts may provide first aid and/or authorise emergency treatment if required.

From time to time Mozhdeh Martial Arts posts photos of our athletes, coaches, and supporters online. Please let us know if you do not consent to this.
How did you find out about us?

Word of mouthFacebookFlyerOther
If you have any questions, please contact coach Eisa on ph 021 0833 3326.

We look forward to seeing you for your FREE trial of Taekwondo!
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Mozhdeh Martial Arts - NZ