Guest Registration | Premier Martial Arts

Participant’s Name*

First Last

Date of Birth*

Participant’s Gender*

Male
Female

Guardian's Name (If Applicable)

First Last

Cell Phone*

Email*

May We Communicate With You Via Text Message?*

Yes
No

Premier Martial Arts Location*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

1. How Did You Happen To Hear About Us?

(If Referral) Referred By

(If Other) Please State How You Heard About Us

2. Do You Live In The Area?*

Yes
No

Do You Plan To Remain In The Area?*

Yes
No

3. Are You Or Your Child In Good Health With No Physical Problems?*

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

Confidence/Self-Image

Respect To Others

Fitness/Activity Level

Leadership (Not A Follower, Doesn't Succumb To Peer Pressure)

8. Would You Like To Invite Someone To Take A Free Lesson With You?*

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*

Consent

I agree to receive text messages from Premier Martial Arts. Message and data rates may apply. You can opt-out at any time by replying STOP.

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Phone

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