Premier Martial Arts - Norton Guest Registration - Premier Martial Arts

Guest Registration

Participant’s Name * Required
First Last
Date of Birth * Required
Month
Day
Year
Participant’s Gender * Required
- Male
- Female
Guardian's Name (If Applicable)
First Last
Cell Phone * Required
Email * Required
May We Communicate With You Via Text Message? * Required
- Yes
- No
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
1. How Did You Happen To Hear About Us?
- Website
- Print Ad
- Social Media
- Sign/Drive By
- Radio/T.V.
- Direct Mail
- Birthday Party
- Promotional Booth
- Referral
- Other
(If Referral) Referred By
(If Other) Please State How You Heard About Us
2. Do You Live In The Area? * Required
- Yes
- No
Do You Plan To Remain In The Area? * Required
- Yes
- No
3. Are You Or Your Child In Good Health With No Physical Problems? * Required
- Yes
- No
Pleas List Any Medical Conditions We Should Be Aware Of
4. Is Your Schedule Such That You Can Arrange For You Or Your Child To Take Lessons Twice a Week?
- Yes
- No
5. Do You Or Your Child Have Any Previous Martial Arts Experience?
- Yes
- No
6. Do You Feel Your Signficant Would Support Your Decision In Getting You Or Your Child Enrolled Provided Our Program Fits Your Needs?
- Yes
- No
7. On A Scale Of 1 - 10, 1 Being Low and 10 Being Great, Please Rate You Or Your Child on the Following:
Focus/Concentration
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Confidence/Self-Image
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Respect To Others
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Fitness/Activity Level
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Leadership (Not A Follower, Doesn't Succumb To Peer Pressure)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
8. Would You Like To Invite Someone To Take A Free Lesson With You? * Required
- Yes
- No
Friend's Name
Friend's Phone
Friend's Email
In consideration for my or my child's attendance and participation in the martial arts training offered by Premier Martial Arts, I acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Premier Franchising Group LLC, Premier Martial Arts International Inc., the school, it's management, assigned staff, and fellow students from liability resulting from bodily injury, virus, any type of contagious sickness, or loss, whether personal belongings or bodily injury. I understand that member images may be used for promotional or training purposes. I agree that I or my child will not attend any event at any time when I or my child believes that they might be ill, is experiencing any symptoms of illness, or has been exposed to a person or persons known to be infected with a contagious illness. I also hereby state that I or my child is physically fit to take the prescribed course of instruction and does so of my own free will.
Guardian Or Adult Student Signature * Required