Application for FREE Trial lesson



 
Student Name:
Adult/Child:
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:
Fitness:
Self Defence:
Flexibility:
Stress Relief:
Hobby:
Weight Loss:
Concentration:
Competition:
Other:


Have you studied a Martial Arts before?

 
Yes or No:
No
Style:
Grade:
Reason for leaving:


Do you suffer from any medical conditions?

 
Yes or No:
No
Details:


When would you like your FREE lesson?

 
Location:
Date:

 

How did you hear about us?

 
How did you hear about us:
Enter "Pomo Code":
If other:
   

 

Bring a friend and have twice the fun!

 

Friends name:
   
Friends email:
   

 
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