Registration Student Name Guardian Name Address City Zip Code Student Information Sex Male Female Birthdate Age Name of school child attending Guardian Information Phone (Mom) Phone (Dad) Phone (Other) Email Occupation Employer Employer Phone What are your learning objectives? Physical Conditioning Cardio Exercise Weight Management Stress Management Social Activities Academic Improvement Self Confidence Self Discipline Self Defense Family Activity Sport Other If other, please elaborate... How did you find our studio? Drive By Flyer Internet Word of Mouth From a Student Other If other, please elaborate... Refer a Friend Name Sex Male Female Age Phone Email Age Restriction × The child must be at least 3 years old to sign up. Age Restriction × This is the child registration form. Do you want to switch to the adult registration form? Signature I/We realize that Mu Do Martial Arts involves the potential for injury which is inherent to any martial arts activities. I/We agree to release Mu Do Martial Arts, its principles, and instructors from such claims or responsibilities for injuries that I/We might receive from these activities. I/We have completely answered the questions above and understand that the fee paid is for the Evaluation Program and is not refundable. By checking this box, I/We agree to the above. Register Child
