Student Application

	Arizona Shaolin Kenpo Academy
	Student Application

Student Name:__________________________________________________________Date:__________________

Student Date of Birth:__________________________________ Parent Name: ______________________________

Address: _____________________________________________ City/ Zip: ________________________________

Home Phone: __ _________________ Work Phone: ___________________ E-Mail: _________________________

Emergency Contact: Name/Realtionship: _____________________________________Phone: __________________

What benefits do you hope to gain from martial art training?_______________________________________________

____________________________________________________________________________________________

Do you have any medical conditions or physical limitations that we need to be aware of? _________________________

___________________________________________________________________________________________

Are you a single parent household? If so other parents name: _____________________________________________

Address: ____________________________ City/zip: ____________________ Phone: _______________________

How did you hear about Arizona Shaolin Kenpo Academy? ______________________________________________

How long do you plan to live in the Phoenix-Metro area?________________________________________________

Studio Policies: The Arizona Shaolin Kenpo Academy reserves the right to dismiss any student at any time for misconduct or other actions which jeopardize the students, staff or reputation of the school!

In addition to this:

1. No refunds after 3 business days.

2. Absolutely No sparring & other assertive contact without Black Belt level supervision and instruction.

3. All male students must wear groin protection in each and every class.

4. Students are to consider the respect and safety of their training partners as their #1 priority!

The undersigned represent that the student named above has no emotional, psychological, or physical illness that could impair their ability to train or make training injurious to them. While every effort will be made on our part to make our classes and facilities as safe as possible, the undersigned realizes that any physical activity has the potential for injury and waive any claim of accidental and/or negligent damage against us and agree to allow the student named above and below to participate in karate or other martial arts related activities.

____________________________________ ___________________________________

Students Name Parents signature (if student is under 18)

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