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    Kick City - Guest - Registration Adult

    Uploaded by

    danalbas
    The document appears to be an adult guest registration form for a martial arts school that collects information such as contact details, health conditions, availability, previous experience, and benefits sought from training. It also includes a liability waiver acknowledging inherent risks and relieving the school of liability for loss or injury incurred during training. The form gathers necessary registration information for new adult students interested in martial arts lessons.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Kick City - Guest - Registration Adult

    Uploaded by

    danalbas
    8 views2 pages
    The document appears to be an adult guest registration form for a martial arts school that collects information such as contact details, health conditions, availability, previous experience, and benefits sought from training. It also includes a liability waiver acknowledging inherent risks and relieving the school of liability for loss or injury incurred during training. The form gathers necessary registration information for new adult students interested in martial arts lessons.

    Original Description:

    Please complete and sign both pages. Return to Kick City to try your free trial lesson!

    Original Title

    Kick City_ Guest_Registration Adult

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    © Attribution Non-Commercial (BY-NC)

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    The document appears to be an adult guest registration form for a martial arts school that collects information such as contact details, health conditions, availability, previous experience, and benefits sought from training. It also includes a liability waiver acknowledging inherent risks and relieving the school of liability for loss or injury incurred during training. The form gathers necessary registration information for new adult students interested in martial arts lessons.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views2 pages

    Kick City - Guest - Registration Adult

    Uploaded by

    danalbas
    The document appears to be an adult guest registration form for a martial arts school that collects information such as contact details, health conditions, availability, previous experience, and benefits sought from training. It also includes a liability waiver acknowledging inherent risks and relieving the school of liability for loss or injury incurred during training. The form gathers necessary registration information for new adult students interested in martial arts lessons.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Adult Guest Registration Form

    Student Name: _________________________________________ D.O.B.: ____________________ M/F: _______

    Spouse: _____________________________________ Occupation: _______________________________

    Home #: _______________________ Cell #: ________________________ Email: _____________________________

    Address: ________________________________________________________________________________________

    City: ___________________________________________ Postal Code: _____________________________________


    1. How did you happen to hear about us:
     Phone Book  Radio/TV  Mailer Coupon
     Newspaper  Demo  Referred by: _____________
     Sign  Birthday Party  Other: ____________

    2. Do you live in the area?  Yes  No


    Do you work in the area?  Yes  No
    Do you plan on to remain in the area?  Yes  No

    3. Are you in good health with no physical problems?  Yes  No


    If no, please list any medical conditions we should be aware of: ___________________________________________

    4. Do you have a place in which you can practice what you learn in class?  Yes  No

    5. Is your schedule such that you can arrange to take lessons twice a week?  Yes  No

    6. Is there anyone you would like to take lessons with?  Yes  No


    Name: ________________________

    7. Do you have any previous martial arts experience?  Yes  No

    Please continue on to the other side


    8. How long have you been interested in taking martial arts?
     Not to long  Couple of Months  Over 1 year

    9. Do you feel your significant other would support your decision in getting in shape and learning self-defense?
     Yes  No

    10. What has prevented you from getting started in a program in the past?
    ______________________________________________________________________________________________

    11. Is this still a problem?


    ______________________________________________________________________________________________

    You will receive all benefits listed below, but please check the most important benefits you would like to receive from
    your training here at Kick City Martial Arts Fitness.

    MENTAL BENEFITS
    Spirit Character Self Control Concentration
    Focus Motivation Self Esteem Determination
    Listening Obedience Goal Setting Goal Setting
    Alertness Leadership Self Respect Manage Stress
    Discipline Persistence Better Grades Self Confidence

    PHYSICAL BENEFITS
    Mobility Relaxation Conditioning Fitness
    Exercise Endurance Reflexes Fun
    Flexibility Muscle Tone Weight Control Self Defense
    Agility Speed Coordination Strength
    Power Balance Cardiovascular Control

    In consideration for my attendance and participation in the martial arts training offered by Kick City Martial Arts Fitness,
    I acknowledge the existence of certain inherent risks n this type of training and hereby agree to assume all risks. I
    further relieve the school, its management, assigned staff, and fellow students from liability resulting from loss, whether
    personal belongings or bodily injury. I also hereby state that I am physically fit to take the prescribed course of
    instruction and do so of my own free will in exchange for an agreed upon fee. I understand there is no refund policy on
    any monies I will pay to Kick City Martial Arts Fitness.

    Signed: ______________________________________________ Date:_______________________________

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