• ADULT

    PARTICIPANT FORM 

  • Todays Date*
     - -

  • Contact Information

  • Format: (000) 000-0000.
  • Gender

  • TRAINING EXPERINCE 

  • Have you ever trained in any martial arts or self-defense before? *

  • TRAINING INTEREST & GOALS 

  • What are the main reasons why you are interested in martial arts or self defense?*
  • What has been the biggest obstacle preventing you from getting started sooner?*
  • Is this still a challenge for you right now? Please Select one*
  • What classes are you interested in? Please Select one*

  • TRAINING AVAILABILITY

  • Are you currently involved in any sports, activities, or exercise program?*
  • If yes, will your participation in that activity, sport, or exercise program interfere with your ability to attend classes on a regular schedule?*
  • Are there any upcoming medical or dental surgeries within the next 12 months that could affect your ability to start training? Or interfere with your ability to attend classes on a regular schedule?*
  • Are there any possibility that your work schedule could interfere with your ability to attend classes on a regular schedule during the next 12 months?*
  • Are you planning on participating in anything in the future that could possibly prevent you from attending class during the next 12 months? Or interfere with your ability to attend classes on a regular schedule?*
  • Are you planning on leaving the area for either a short time period or for an extended period of time within the next 12 months?*
  • Are you planning on permanently moving during the next 12 months?*
  • When do you realistically plan on starting classes?*

  • TRAINING  BUDGET

  • Have you set aside a budget for your training?*
  • Can you comfortably budget somewhere between $40 to $80 each week for your training?*

  • LOCATION 

  • What part of town are you coming from?*

  • DECISION MAKERS & SUPPORT 

  • Will a spouse, partner, or significant other be involved in your decision to enroll?*
  • Format: (000) 000-0000.
  • Is there anyone else you need to consult with before Enrolling?*
  • If yes or no, select one:*

  • HEALTH & SAFETY

  • Do you have any physical limitations or injuries that we should be aware before you start training?*
  • Do you have any medical conditions, or special considerations we should be aware of before you start training?*
  • Are you currently taking any kind of medication?*
  • If yes, will the medication affect physical activity, balance, focus, or participation during training?*

  • TRAINING COMMITMENT

  • What type of workout are you interested in? Select one:*
  • How many days a week would you like to attend? Select one:*
  • What Days are best for you to attend classes? Select any that work best for you!*
  • What times are best for you to attend classes? Select Any*
  • Is earning a Black Belt something your interested in? Select one:*
  • Should be Empty: