City Champs Class Registration

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Please fill out the form to register for free jiujitsu classes.

(one form for each student)

White Lotus Jiujitsu (Southside Location-420 S 1st St. Milwaukee, WI 54204)

Wednesdays 4:00-5:00pm- Kids class (ages 6-12)

Thursdays 4:00-5:00pm-Teen class (ages 13-18)

Combat Corner City Training Center (Northside Location-6353 W Douglas Ave, Milwaukee, WI 53218)

Mondays 4:00-5:00pm-Youth class (ages 6-18)

Which class(s) are you registering for? *

White Lotus: Wednesdays 4:00-5:00pm- Kids class (ages 6-12)

White Lotus: Thursdays 4:00-5:00pm-Teen class (ages 13-18)

City Training Center: Mondays 4:00-5:00pm-Youth class (ages 6-18)

Required

Youth Full Name *

Parent/Guardian Full Name *

Child's Gender *

Female

Male

Non-binary

Prefer not to say

Youth Ethnicity *

White

African American

Native Hawaiian or Pacific Islander

Asian

American Indian or Alaskan Native

African American & White

Asian & White

American Indian or Alaskan Native & White

Other Multi-Race

Prefer not to say

Youth Date of Birth *

YYYY

Phone Number
*

Email Address *

Address

City

State

Zip Code

Where did you hear about us?
*

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