Registration

Please indicate what you would like to register for:

Tai Chi Chuan

Kung Fu

Chi Kung

Kung Fu for Kids

Seniors

Meditation

Seminar

Women's Wellness Journey

Spiritual Journey

Program Location

Name

Cell Phone / Landline: Specify

address (include Postal Code)

Birthdate

Occupation

Emergency Contact ( Name & phone number)

Please indicate your general health or any health concerns we should know about.

What do you hope to gain from this program?

Previous Martial Arts or fitness experience?

How did you hear about Temple Knights?

Search Engine

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Would you like to receive our monthly email newsletter?

Additional Comments (optional)

Waiver: ( To be signed when you attend your first class). By signing this registration form I certify that the above information is correct. As as participant, I acknowledge that Temple Knights Martial Arts and their representatives shall in no form be liable or responsible for injury, bodily harm ocurring to me during classes and that such risks shall be borne by me voluntarily. Our policy after registration payment is made is no refunds except for medical reasons. However, makeup classes, credits or credit transfers for products or membership can be arranged. (optional)

Date: (optional)

Signature or Guardian's signature: (optional)