What motivated you to consider Tae Kwon-Do?:
Student Name(last):   (first):
Address:
City:    Zip:
Home Phone:   Work:
Email Address:
Single:    Married:   Date of Birth:   Age:
Prior Martial Arts Experience:
If applicant is a minor, parent or gaurdian's name:
Employed by:   Phone:
Are you planning to move from the above address?   if yes, when?:

If you are approved for this program, will you attend at least two classes a week?:
How long have you been interested in taking Tae Kwon-Do?:

Current athletic activities or hobbies:
Do you have any health problems?:

Our academic policy for young student black belt is a "B" average or above. Can you maintain or achieve a "B" average or above for your Black Belt?

What are your reasons for taking Tae Kwon-Do?:
Self Defense   Lose Weight   Self-Confidence   Self-Discipline
Physical Conditioning   Concentration Problems   Recreation   Stress Relief
Other  

How did you find out about our program?:   Sign   Flyer   Newspaper
Yellow Pages   Coupon  Member(name):
Other:

Which of your family/friends would like to invite for a trial lesson?
Friends name:    Phone#: