Adult Martial Arts Class Registration
Name
*
First Name
Last Name
Date of Birth
*
Age
*
Gender
*
Male
Female 2
Non-Binary
Prefer not to say
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name & Relationship
*
Emergency Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health Information
Asthma
Heart Condition
Diabetes
Joint Problems
Back pain
Other
Are you currently taking any medications?
*
Yes
No
Have you practiced Martial Arts before?
*
Yes
No
If yes, what style(s) and for how long?
Do you have any medical conditions or allergies we should be aware of?
Waiver and Consent
*
I understand that martial arts involves physical activity and assume full responsibility for any injuries incurred during training. I release the school, instructors, and affiliates from any liability.
I agree to follow all rules and safety guidelines.
I give consent for photos/videos taken during class to be used for promotional purposes.
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