Yun Jung Do Registration Form
Select Your Class
Please Select
Monday Junior 4-12years 7:00-7:30pm $10
Tuesday Junior 4-12 years 6:00-6:30pm $10
Monday Seniors 7:00-8:30pm $20
Tuesday Seniors 6:00-7:30pm $20
Both Junior trainings deal $60 month (normally $80)
Both senior trainings $40 week (serious training)
Personal Details
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Martial Arts Experience
Primary Martial Art Style or please say if Beginner
*
Years of Experience
*
Current Rank/Level
Current Injuries or Pain
Are you currently experiencing any injuries or pain?
*
No
Yes
Please describe your current injuries or pain (if any).
Emergency Contact
Emergency Contact Name
*
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Consent and Waiver
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Submit Assessment
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