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Name - 1st Family Member

Birth Date

Age

Height

Weight

Select Only One Program:

$100.00 Introductory Program I

$180.00 Introductory Program II

List Known Health Concerns:

$80.00 Per Month

$275.00 Pee Wee Session One

$200.00 Pee Wee Session II, III, IV

Name - 2nd Family Member

Birth Date

Age

Height

Weight

Select Only One Program:

$100.00 Introductory Program I

$180.00 Introductory Program II

List Known Health Concerns:

$40.00 Per Month

Name - 3rd Family Member

Birth Date

Age

Height

Weight

Select Only One Program:

$100.00 Introductory Program I

$180.00 Introductory Program II

List Known Health Concerns:

$5.00 Per Month

Name - 4th Family Member

Birth Date

Age

Height

Weight

Select Only One Program:

$100.00 Introductory Program I

$180.00 Introductory Program II

List Known Health Concerns:

$0.00 Per Month

Total:

ProviderName:

Address:

City:

State/Prov:

Country:

Zip/Post. code:

Phone:

E-mail:

Method of Payment

Check or cash on first visit.

Credit Card

NOTE: If you are paying with a credit card please come back here after submitting the registration form and proceed with payment.  After online payment has been completed, print the waiver form below, fill out the form and bring it with you to your first class. You will not be permitted to participate if you do not have the form.

CLICK HERE AND PRINT WAIVER FORM


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Martial Arts training involves physical and disciplinary techniques that could produce bodily injury. All training is at the customer's own risk.