Membership Registration Form

Preferred Class Location*
I Would Like To Register*
- Myself (Individuals over 19 years)
- My Child (under 19 years)
- My Children (under 19 years)
- My Family
Family Registration
How Many Adults?
Name*
First Last
Name*
First Last
How Many Children?
Child
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Child 2
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Child 3
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Child 4
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Child Registration
Childs Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Parent/Gaurdian Name*
First Last
Single Registration
Name*
First Last
Contact Info
Phone*
Email*
Street Address*
City*
Prov*
Postal Code*
Home Phone*
Cell Phone
Additional Questions
Health Problems*
- None
- Yes
Temporary or permanent that could be affected by strenuous physical training. Always check with your doctor before beginning any course of rigorous activity. This item may not be left blank. If you have no health problems enter “NONE”.
Please Describe
Previous Martial Arts Training History
Additional Comments

Family Registration