Application for FREE Trial lesson
Student Name:
Adult/Child:
Adult
Child
Address:
Date of birth:
Telephone:
Email:
What are your key motivations for wanting to learn Martial Arts?
please complete accordingly (importance 1 = low
.
7 = high)
Confidence:
<Please select>
1
2
3
4
5
6
7
<N/A>
Fitness:
<Please select>
1
2
3
4
5
6
7
<N/A>
Self Defence:
<Please select>
1
2
3
4
5
6
7
<N/A>
Flexibility:
<Please select>
1
2
3
4
5
6
7
<N/A>
Stress Relief:
<Please select>
1
2
3
4
5
6
7
<N/A>
Hobby:
<Please select>
1
2
3
4
5
6
7
<N/A>
Weight Loss:
<Please select>
1
2
3
4
5
6
7
<N/A>
Concentration:
<Please select>
1
2
3
4
5
6
7
<N/A>
Competition:
<Please select>
1
2
3
4
5
6
7
<N/A>
Other:
Have you studied a Martial Arts before?
Yes or No:
Yes
No
Style:
Grade:
Reason for leaving:
Do you suffer from any medical conditions?
Yes or No:
Yes
No
Details:
When would you like your FREE lesson?
Location:
<Please select>
Ascot - Monday
Windsor - Tuesday
Ascot - Wednesday
Windsor - Thursday
Bracknell - Tuesday
Date:
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