STUDENT APPLICATION
NAME_____________________________________________DOB____/_____/______
(FIRST) (M.I.) (LAST)
PARENT/GUARDIAN____________________________________________________
ADDRESS______________________________________________________________
CITY__________________________________________ZIP CODE________________
HOME/CELL PHONE_______________/_______________WORK PHONE___________
EMAIL ADDRESS________________________________________________________
EMPLOYED BY______________________________________HOW LONG_________
HOW DID YOU HEAR ABOUT OUR STUDIO? _______________________________
In order for us to determine if the instruction at North Pole Martial Arts can adequately meet and serve your needs,
please complete the following questionnaire.
Check the benefits you would like to experience from Taekwondo training at North Pole Martial Arts.
( ) PHYSICAL CONDITIONING
( ) BETTER CONCENTRATION
( ) SELF CONFIDENCE Paid Intro______ Free Intro_____
( ) FAMILY BONDING
( ) SELF DEFENSE Begin___/___/___ End___/___/___
( ) WEIGHT CONTROL
( ) MORE ENERGY
( ) SELF DISCIPLINE
( ) ATHLETIC SKILLS
( ) BETTER MENTAL ATTITUDE
( ) TEMPER CONTROL
( ) SELF CONTROL
( ) RESPECT FOR SELF AND OTHERS
( ) OTHER___________________________________________________________
CIRCLE THE ANSWER THAT APPLIES TO YOU
Will you be living in the area for at least one year? YES NO
Tuition for Taekwondo is approximately $65 per month. Is the tuition within your budget? YES NO
Students are expected to attend classes an average of twice per week. Can you meet this requirement? YES NO
Once you set a goal do you persist until you have reached your objective? YES NO
Are there any special condition, medical or otherwise, that we should be aware of?
______________________________________________________________________________