Wah Lum Application for Online Training
Thank you for your interest in Wah Lum Kung Fu & Tai Chi!

Please fill out the questionnaire below to see if we are a good fit to begin online training.
Email address *
Name *
First and last name
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Emergency Contact *
Name and number
Your answer
Do you have any medical conditions? *
If you answered "yes" to the above question, please specify your medical concerns and any medications you are taking. *
Your answer
I am interested in signing up for the following Wah Lum Classes: *
Required
I am interested in: *
Required
Have you ever done martial arts before? If yes, please write down your previous experience and instructors.
Your answer
How did you hear about the Temple? *
Your answer
What are your goals with Wah Lum Online classes?
Your answer
Once we are no longer in quarantine, I plan to train at a Wah Lum School near me. *
If my application is accepted, I agree to abide by the following online rules: *
Required
By clicking yes and typing my name below, I agree this acts as my official signature and it will be applied to this application and will have the same effect as a legal signature. *
Your answer
Are you sure you want to apply your electronic signature to this application? By clicking yes you agree to the terms and conditions of this application, and this electronic signature will have the same effect as a handwritten signature. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy