Raise Leaders - Free Trial Class

1
Name of Student* This field is required.
First Name
Last Name
2
Age of Student* This field is required.
Please Select
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
3
Which class would you like to try?* This field is required.
Little Ninjas Age 3-7
Black Belt Leadership Ages 8-12
Athletic Leadership Ages 13-17
4
Which date would you like to try class?
Date
Month
Day
Year
5
Parent or Guardian Name* This field is required.
First Name
Last Name
6
Email* This field is required.
example@example.com
7
Phone Number* This field is required.
8
Trial Class Permission & Waiver

By signing below, I give permission for my child to participate in a trial class at Raise Leaders Martial Arts and understand that physical activity involves some risk. I release Raise Leaders Martial Arts and its owners and staff from liability except in cases of gross negligence. I also authorize emergency medical treatment if needed. I agree that Raise Leaders Martial Arts may contact me by phone or text to confirm class details and provide program information.
9
Signature
Clear
Should be Empty: