Golden Lion Signup

Golden Lion Martial Arts Application Form
Location*

Albany, Ca. 510-455-4430Sausalito, Ca. 415-331-8838
I want to train in:

Kung FuTai Chi Chuan
Name*

First NameLast Name
Parent/Guardian

First NameLast Name
Male/Female/Other*

MaleFemaleOther
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Birthday*

MonthDayYear
Age
I understand that my payments continue even if there is a break in my attendance.

The student or guardian should notify the Golden Lion Martial Arts School of missed weeks.

I understand there is no refund for any fees or tuition paid.
In Studio Training:
Fees (Please select one training plan):

Kung Fu - Cubs ages 4 1/2 to 6 years ($255 Initial, $145 Monthly)Kung Fu/Tai Chi Chuan - Youth/Teens/Adults ($345, $195 Monthly)2 Days Introductory Program - $45 (Free t-shirt, Introductory fee will be applied towards FULL initial signup tuition)Drop in (Adult classes only) - $35 per sessionRedeem Gift Certificate
Office Use Only: Paid cc _____ ck _____ cash ______ other ______
Payment can be collected at the studio or over the phone. Credit cards (mastercard and visa), cash or checks accepted.
Rights of Cancellation:
1. You may cancel this agreement within 3 business days from the start date without penalty or obligation. You may incur fees if credit card payment was submitted.
2. If student becomes disabled for at least 2 months during the membership terms and that disability is confirmed in writing by a physician, you have a right to an extension or cancellation of this agreement.
3. 30 days notification of cancellation of above training program, either written and delivered or emailed with a reply.
* Until terminated by student or studio with no further obligations.
Date*

MonthDayYear
Please sign to authorize training. I have read, understand and agree to all conditions set forth on this application.

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Golden Lion Martial Arts Application Form