New Kids Quick Start Application Form

Parent's Name* This field is required.

First Name

Last Name

Child's Name* This field is required.

First Name

Last Name

Child's Date of Birth* This field is required.

Child's Height and Weight* This field is required.For Uniform Size

Which best describes your child's age group?* This field is required.

Is there anyone we should thank for referring you to Dragon Gym?* This field is required.

Which Dragon Gym Location will you be attending for the Quick Start Course?* This field is required.

What is the primary goal of enrolling your child in martial arts classes?* This field is required.

Select any additional goals that it's important for your child to achieve:* This field is required.

Better Grades

Making Friends

Self-Discipline

Increased ability to focus and pay attention

Better Behavior at Home

Physical Fitness

Learn Self-Defense

Increased Self-Confidence & Esteem

More Energy

Better Mindset

Leadership Skills

Why are these goals important to you?* This field is required.

Have you tried to achieve these goals in the past? Why do you think you were not 100% successful?* This field is required.

I believe my child can achieve these goals because.* This field is required.

How much time per week would you be willing to spend to permanently achieve the goals listed above.* This field is required.

After seeing improvements, how committed are you and your family to maintaining those improvements, on a scale of 1 - 10.* This field is required.

I believe that one of the most important lessons a child can learn is to persevere when things become difficult.* This field is required.

TRUEFALSE

Tell us a little bit about a time when things were difficult and your child was successfully motivated to persevere.* This field is required.

I believe my child would benefit from having more self-discipline.* This field is required.

TRUEFALSE

How is self-discipline taught at home?* This field is required.

On average my child spends hours * hours per week interacting with peers in a non-academic setting.

On average my child spends hour * on electronic devices.

Most of our students who make it past green belt, end up dedicating themselves to martial arts year round, and eventually move on to becoming Black Belts. This is a goal I would be supportive of.* This field is required.

TRUEFALSE

Imagine three years from today, and you were looking back over those three years. What has to have happened in your child’s life, both mentally and physically, for you to feel happy with their progress at Dragon Gym?* This field is required.