The Bully Proof Academy Membership Registration Form

The Bully Proof Academy Membership Registration Form
Membership Program Details
NOW ENROLLING!

Looking for a positive, theraputic, motivating, educational and confident driven peer group for girls?! Look no further! The Bully Proof Academy focuses on Character Development and Walking with Confidence!

MEMBERSHIP INCLUDES:

Members receive a monthly schedule a month in advance, outlining upcoming events and sessions. These sessions take place on various days throughout each month, giving flexibility for all students. Activities may include self-defense training, small group discussions, group outings, outdoor activities, community service, zoom meetups, workshops on mastering emotions, social skill development, strength and conditioning, entrepreneurship and young professional training, and more. Each session is distinct and offers a unique experience.

The Bully Proof Academy focuses on 7 Key Principles:
- Personal Development
- Mastering Emotions
- Conflict Resolution
- Mindfulness Techniques
- Self-Defense/ Combat Skills Training
- Nutrition/Fitness
- Social Skills
WHO CAN PARTICPATE: Girls ages 10y-18y

COST: $39/per month. May cancel anytime with a written 30 day notice. All new memebership payments will begin on the 1st of the following month.
Parent/Guardian Name*

First NameLast Name
Email Address*
parentORguardianemail@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Child Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Child's Phone Number (if applicable)
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name*
Emergency Contact Phone Number*
Please enter a valid phone number.
Why do you want to join The Bully Proof Academy?*
How did you hear about The Bully Proof Academy?*
Card Holder Name*

First NameLast Name
Card Holder Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Card Number*
0000-0000-0000-0000
Expiration Date*

MonthDayYear
Security Code*
123 (on back of card)
Should be Empty: