2022 Class Registration Form

2022 Class Registration Form
How did you hear about MMAA?
Students Name *

First Name Last Name
Students Date of birth *

Month Day Year
Date
Parent/Guardian Name (if student is under 18 yrs)

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Parent/ Guardian/ Student Phone Number *
Please enter a valid phone number.
Are there any medicial conditions we need to be aware of? If YES please explain below -
Class Selection *

Mini Dragons (3-5yrs) Junior Dragons (6-8yrs) Dragons (9-12yrs) Adults (13yrs +)
Membership Selection *

MINI DRAGONS MEMBERSHIP - $25.00* per week (Direct debit) Registration fee: $100 This membership includes 1 class per week. Uniform included *Conditions apply GOLD MEMBERSHIP - $35.00* perweek (Direct debit) Registration fee: $150 This membership includes 2 classes per week. Uniform included *Conditions apply PLATINUM MEMBERSHIP - $40.00* perweek (Direct debit) Registration fee: $150 This membership includes UNLIMITED classes per week. Uniform and sparring gear included *Conditions apply
Emergency Contact 1 *

First Name Last Name
Emergency Contact 1 Phone Number *
Please enter a valid phone number.
Emergency Contact 2 *

First Name Last Name
Emergency Contact 2 Phone Number *
Please enter a valid phone number.
Signature

Clear
Maitland Martial Arts Academy

29 St Andrews Street, Maitland NSW 2320 Ph: 0423 226 095

www.maitlandmartialartsacademy@gmail.com
Should be Empty: