Healing Through Movement
Youth Muay Thai Program
SIGN UP FORM FOR AGES 6-11 YEARS OLD
Please fill out form in full for your child to be fully signed up for this program!
YOUR CHILD'S PERSONAL INFORMATION
Child's Name
*
First Name
Last Name
Child's Age
*
This form is for 6-11 years ONLY!
Please tell us if your child is Indigenous?
*
First Nations
Inuit
Métis
Does your child have any experience in Muay Thai?
*
Beginner - No Experience
Intermediate - Some Experience
Expert - Lots of Experience
Is there any medical conditions we should be aware about?
*
Please list all medical conditions and any allergies!
PARENT/GUARDIAN INFORMATION
Full Name
*
First Name
Last Name
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 INFORMATION
Name of Contact ( Please list a Secondary Contact)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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FINAL PAGE
PLEASE READ!
PLEASE NOTE - Once you hit submit, we will receive your email submission and your child will be register for this program! Once start date is confirmed, you will get an email or call back with further details. Thank You!!
SUBMIT
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