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               Student Application

 

Name:   Phone#     

Address  State  Zip 

Employer  Phone

 

What Are the main reasons why you want to take martial arts lessons?

 

How did you hear about us?

  Website                                                                                 For Office Use Only

 Student Referral                                                                Registration Fee

  Other                                Group Lessons

                                                                                               Private Lessons

        Do you have any medical problems that the instructor should            Other

        be aware of?                                                                                  Total   

            Yes                                                                                            Deposit

            No                                                                                           (all payments are non-refundable)

Long Beach Tang Soo Do Academy reserves all rights to dismiss any students, at any  time for misconduct or actions which may convey a bad image.

I hereby acknowledge that Long Beach Tang Soo Do Academy is not responsible for any injuries suffered while on these premises

_________________________________                            _______________________________

(parent must sign is under 18)                                                                        Instructor

please fill out, print out and take to the studio