Intro Capoeira Class Registration
Email address *
Which class are you or your child taking? *
First Name (Parent/Guardian if under 18yrs old) *
Your answer
Last Name (Parent/Guardian if under 18yrs old) *
Your answer
Phone *
Your answer
Email *
Your answer
Current Address
Your answer
Gender
Child's Name, age and gender *
Your answer
Please list any physical limitations and/or developmental/learning needs. *
Your answer
Do you have any of the following: *
Required
What made you want to learn capoeira?
Your answer
Have you studied capoeira before? If yes, for long and where.
Your answer
What are you looking gain and/or learn from capoeira?
Your answer
How did you hear about this class? *
I authorize the verification of the information provided on this form is correct. I understand that this information is for recorded purposes only. Please date and sign below if you are the parent and/or legal guardian. (Print name and date) *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.