New Member Intake Form
Please fill out this form so we can understand more before scheduling an IN PERSON meet & greet.
*** If you have MORE THAN ONE potential member, you MUST submit this form for EACH .***
*** Minimum age requirement is 4  years old at time of appointment  (48 months, no less) ***
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Email *
How did you hear about us? Referred by? *
Parent/Guardian First & Last Name *
Primary cell phone number *
Town you reside *
Potential Member First & Last Name *
Date of Birth (potential member) *
MM
/
DD
/
YYYY
Any previous martial arts experience? If so, please explain where and for how long.  *
If special needs inquiry please explain the diagnoses. *
Long and short term goals *
Additional comments you would like to share
What days AND times are best to schedule a meet and greet with head instructor? Please give several options and be specific. Thirty minutes are blocked out free of charge. *
Please note: We are closed Fridays and Sundays.
A copy of your responses will be emailed to the address you provided.
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