Children’s Application

Student Information:

First name:
Last name:
Gender:
Date of birth:
Email address:
Phone number:
Address:
City/Town:
State:
Zip:

School Information:

School:
Grade:

Emergency Contact Information:

First name:
Last name:
Relationship:
Phone number:

Student Questionnaire:

1. Has your child trained in the martial arts before?  Yes No
1a. If yes to question 1. What style? How long did he or she train? When did he or she last train?
2. How would you rate your child's health?  Excellent Good Average Poor
2a. If your child has any health problems, please list them:
3. Did your child request this training, or is it something you believe that will be of value to him/her?
4. Why are you interested for your child to learn martial arts?  I want my child to learn how to defend him/her self I want my child to gain self confidence in his/her abilities I want my child to strengthen his/her health I want my child to improve in his/her self-control and self-discipline I want my child to be involved in a beneficial athletic program
5. What do you value most for your child at this time?
6. If your child is accepted, do you think you and your child would want to set a goal on becoming a black belt someday?
7. How did you hear about our martial arts school?