Stone Ridge:
42015 Village Center Plaza Suite 135 Aldie VA 20105
703.542.2130
Lorton:
7744 Gunston Plaza Lorton VA 22079
703.339.9400
www.kongsktlc.org
Visitor information form
Student's Name
*
First Name
Last Name
Student's Name
First Name
Last Name
Student's Name
First Name
Last Name
Age
*
Gender
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Female
Age
Gender
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Parent/ Guardian Name
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First Name
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Best Contact number
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Format: (000) 000-0000.
E-mail
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What benefit among the following options are you primarily interested in?
improve Focus
Self Defense
Culture/Philosophy
Physical fitness
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Positive Attitude
Increase Energy
Lose Weight
Do you have any previous Martial Arts experience?
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Appointment for 6 year to 12 year
Appointment for 12 year to Adults
Choose Trial Program
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2 Week Trial Program
4 classes with TKD uniform
$39.99
$
39.99
Quantity
1
2
3
4
Item subtotal:
$0.00
$
0.00
1 Week Trial Program
3 classes without the TKD uniform
$9.99
$
9.99
Quantity
1
2
3
4
Item subtotal:
$0.00
$
0.00
Payment Methods
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