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Wah Lum Application
Thank you for your interest in Wah Lum Kung Fu & Tai Chi!
Please fill out the questionnaire below.
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Email
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Your email
Name
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First and last name
Your answer
Date of Birth
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MM
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DD
/
YYYY
Street Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Phone #
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Name and number
Your answer
Do you have any medical conditions?
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Yes
No
If you answered "yes" to the above question, please specify your medical concerns and any medications you are taking.
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Your answer
I am interested in signing up for the following Wah Lum Classes:
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Kung Fu
Tai Chi
Fitness/Strength Training
Required
I am interested in:
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Group Classes
Private Lessons
Required
Have you ever done martial arts before? If yes, please write down your previous experience and instructors.
Your answer
How did you hear about the Temple?
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Your answer
What are your goals with Wah Lum Online classes?
Your answer
Once we are no longer in quarantine, I plan to train at a Wah Lum School near me.
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Yes
No
There is no school nearby
If my application is accepted, I agree to abide by the following online rules:
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I agree to abide by the original Wah Lum Kung Fu Temple, Inc. member agreement which will be sent to me digitally.
I will show a respectful attitude online, as I would be at the Temple.
I agree to maintain my monthly membership dues to have access to online classes if I decide to enroll.
I agree that if I miss the online time, I forfeit that class for the day.
I will NOT video tape, record, or attempt to duplicate the online class in anyway.
I agree that to maintain a private workout environment.
I understand that video is an optional feature, and may opt out of video during the lesson.
I agree I am choosing to exercise at home at my own risk.
I will respect the privacy of the instructors and my fellow classmates.
Required
By clicking yes and typing my name below, I agree this acts as my official signature and it will be applied to this application and will have the same effect as a legal signature.
*
Your answer
Are you sure you want to apply your electronic signature to this application? By clicking yes you agree to the terms and conditions of this application, and this electronic signature will have the same effect as a handwritten signature.
*
Yes
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