Trial Class Student Evaluation Form

Trial Class Student Waiver Form
What day would you like to schedule your free trial class? (Only Available Monday, Tuesday, or Wednesday) *

Month Day Year
Date
Pick a Class: *

5:00 to 5:40 Monday or Wednesday 6:20 to 7:00 Monday or Wednesday 5:30 to 6:10 Tuesday or Thursday 6:50 to 7:30 Tuesday or Thursday
Student's Name: *

First Name Last Name
Birth Date: *

Month Day Year
Gender: *

Male Female
Student's Name:

First Name Last Name
Birth Date:

Month Day Year
Gender:

Male Female
Student's Name:

First Name Last Name
Birth Date:

Month Day Year
Gender:

Male Female
Parent/Guardian Information 1
Name: *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Number:

Area Code Phone Number
Cell Number: *

Area Code Phone Number
E-mail: *
Are you a student at another Martial Arts school? *

Yes No
If yes, Name of school:
Any physical or mental health conditions that may affect you (or your child's) ability to participate in class? *

Yes No
If yes, please explain:
What are you interested in? *

Evening Martial Arts Class After School Program Before Care Summer Camp
Any Martial Arts Experience? *

Yes No
If yes, please describe:
Why are you (your child) interested in martial arts?
What do you (you child) look to gain from learning martial arts?
How did you hear about us? *

Drive by Website Facebook Saw our van Birthday Party
Referred by:
Waiver:

I recognize and acknowledge that there is a known risk of injury involved in the participation of any Martial Arts program. I agree to assume this risk and agree that Kang’s Mixed Martial Arts and all persons participating in the Instruction/Management at Kang’s Mixed Martial Arts will not be held liable for any damages or injuries caused by the use or practice of any of the techniques presented in the classes. I understand also that I, or my child (if signing as a parent) do not have to participate in any activity or training exercise that I do not feel is in my best interest.
Signed:

Clear
Date

Month Day Year
Should be Empty:

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Trial Class Student Waiver Form