New Student Assessment
Please complete this form to the best your ability prior to arriving for your student assessment. This will help us further guide you in the right direction with our programs. All information is kept strictly confidential.
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Student Name (First & Last) *
Date of Birth *
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Gender
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Street Address
City/Town
Province
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Main Contact Number
555-888-1234
Main Contact Email
How Did You Hear About Us?
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Emergency Contact Name
Emergency Contact Number
555-888-1234
Marital Status
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If Married, will your spouse be taking class with you?
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Will you be able to attend class twice a week?
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Are there any physical or learning disabilities that we should be aware of?
Have you ever trained in martial arts before?
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Are you going to be living in the area for more than 12 months?
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Do you have a place to practice aside from the academy?
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What classes are you most interested in?
Check the boxes that best describe you
Please select the benefits you would like to receive as a member of Union Martial Arts
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