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New Member Intake Form
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Email
*
Your email
How did you hear about us? Referred by?
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Your answer
Parent/Guardian Name
*
Your answer
Primary cell phone number
*
Your answer
Town you reside
*
Your answer
Potential Member Name(s)
*
Your answer
Date of Birth (potential member)
*
MM
/
DD
/
YYYY
Any previous martial arts experience? If so, please explain where and for how long.
*
Your answer
If special needs inquiry please explain the diagnoses.
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Your answer
Long and short term goals
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Your answer
Additional comments you would like to share
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What
days AND times
are best to schedule a meet and greet with head instructor?
Please give several options and be specific.
Thirty minutes are blocked out free of charge.
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Your answer
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