Application for Training

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PLEASE SELECT ONE: Martial Arts  Cardio Karate     Date:

NAME:    AGE: D.O.B.

NAME:     AGE:   D.O.B. 

NAME:     AGE:   D.O.B. 

ADDRESS:

CITY:     STATE:         ZIP:

PHONE: Home: Work: Cell:

OCCUPATION:

PARENT'S/GUARDIAN'S NAMES:

HAVE YOU PREVIOUSLY TRAINED BEFORE? YES NO 

IF YES, WHAT STYLE?

DO YOU HAVE ANY MEDICAL CONDITIONS THAT THE INSTRUCTOR NEEDS TO BE AWARE OF?

YES NO  IF YES, PLEASE EXPLAIN

HOW DID YOU HEAR ABOUT US? Yellow Pages    Print Ad    Radio/TV     Direct Mail    The Internet

                                                       In House Promo   Word Of Mouth    Lead Box    Drive By

                                                       Recommended By A Friend?

                                                                     If so, by whom?

CHOICE OF CLASSES: AND

Fred Villari's Studios of Self Defense reserves the right to dismiss any student for misconduct or actions which may convey a bad image of the Fred Villari's Studios of Self Defense.

I hereby acknowledge that Fred Villari's Studios of Self Defense is not responsible for injury suffered on the premises.  The undersigned assumes all the risk inherent and incidental to this type of sports activities as a condition for applying for admission to this karate studio.

NAME OF STUDENT:

NAME OF PARENT OR GUARDIAN:

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