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NZ Wushu Academy - New Student Registration Form
Student Information
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* Indicates required question
Full Name of Student:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Gender:
*
Male
Female
Name of Parent / Guardian (if student under 18 years old):
Your answer
Emergency contact if different from above (name & number):
Your answer
Address:
*
Your answer
Phone number:
*
Your answer
Email:
*
Your answer
Free Trial Date
MM
/
DD
/
YYYY
Please select type of class:
*
Wushu
Sanda
Tai Chi
Development Squad
Other:
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