Golden Lion Signup

Golden Lion Martial Arts Application Form

1031 San Pablo Avenue, Albany Ca 94706 510 - 527 - 1606
Name *

First Name Last Name
Parent/Guardian

First Name Last Name
Male/Female/Other *

Male Female N/A
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Birthday *

Month Day Year
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.
I want to train in:

Kung Fu Tai Chi Chuan
In Studio Training:
Fees (Please select one training plan):

Kung Fu - Cubs ages 4 1/2 to 6 years ($225 Initial, $125 Monthly) Kung Fu - Youth/Teens/Adults ($285, $185 Monthly) Tai Chi Chuan - ($285, $185 Monthly) 3 Days Introductory Progam - $35 (Free t-shirt) 6 months or 12 months paid in full, discounted. Please Call 510-527-1606
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 *

Month Day Year
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