Aikido NLC Trial Form (Child)
This is a digital version of our registration form. Some paperwork will need to be signed in person. Family Dynamic is to help us with communication with everyone in the family. If you have more than one child, please include other children's names and birthday in the other section or fill out a second form.
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Guardian
First Name
Last Name
Relation
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Secondary Guardian
First Name
Last Name
Relation
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Family Dynamic
What are you looking to work on?
Better School Grades
Discipline
Fun
Learn Martial Arts
Fitness
Cultivate Calm
Japanese Culture
Social, Make New Friends
Self-Defense
Self-Esteem, Confidence
Bully Prevention
Other
How did you hear about us?
Back Pack Raffle
Sign
Google
Social Media
Friends/Family
Event
Birthday Party
Other
Please list other children and their birthdays
Is there anything we need to know that would help your child succeed?
Parent/Guardian Signature
Submit
Should be Empty: