MK MUAY THAI ACADEMY NEW STUDENT APPLICATION

MK MUAY THAI ACADEMY
Date*

MonthDayYear
Date
New Student Info
Name*

First NameLast Name
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Phone*
Date of Birth

MonthDayYear
Date
Email
example@example.com
Martial Arts Background
What are the main benefits you hope to gain from Martial Arts Training?

Self DefenseFitnessAttention SpanCompetitionConfidenceSelf ControlWeight ControlStress ReductionOther
How did you hear about our Academy

Walk-inInternetFlyer / PostcardReferral
Referred by
Do you have any medical problems or considerations that the instructor should be aware of?
I hereby acknowledge that MK Muay Thai Academy, MK Muay Thai LLC, head instructor, Augie Matias, and/or its staff and students are not responsible for any injuries that may occur on premises.
Signature*

Clear
(Parent/Guardian must sign if under 18 years of age)
Should be Empty:

MK MUAY THAI ACADEMY