CBBA Child Evaluation Form 2020
Please complete the following form to the best of your ability. Rest assured, all information will be kept strictly confidential.
Student's First Name *
Student's Last Name *
Street Number and Name *
City/Town
Province
Country
Postal Code
Mother's Full Name / Guardian
Mother's / Guardian Contact Number
555-444-1234
Mother's / Guardian Email
Father's / Guardian Full Name
Father's / Guardian Contact Number
555-444-1234
Father's / Guardian Email
How did you hear about us?
If you were referred by someone, who can we thank?
Child's Date Of Birth
MM
/
DD
/
YYYY
Child's Gender
Emergency Contact Name
Emergency Contact Phone
555-444-1234
Marital Status of Parents
If divorced, will both parents be involved?
Does the student have any physical or learning disabilities that we should be aware of?
Has your child ever trained the martial arts before?
Clear selection
Are you going to be living in the area for at least 1 year?
Clear selection
Are you able to attend class twice per week?
Clear selection
Who initiated your child's enrollment in Martial Arts?
What made you want to try our Academy?
Are both parents supportive in regards to martial arts lessons?
Clear selection
Which programs are you most interested in?
Please select the boxes which best describe your child's personality:
What other sports/activities does your child participate in? Please list.
What academic school does your child attend?
Does your child know any students that already participate here at our Academy?
Clear selection
Please prioritise the top 3 reasons why you want your child to take martial arts lessons:
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