Spencer’s
Warrior Club-Tae Kwon Do
“To subdue your enemy
without fighting-is the highest skill”-Sun Tzu
NAME________________________________________________DOB_____/_____/_____AGE_____SEX_____
MN DY
YR
NAME________________________________________________DOB_____/_____/_____AGE_____SEX_____
MN DY
YR
PLEASE
PRINT MN DY
YR
ADDRESS___________________________________________CITY________________ST______ZIP_______
E-mail Address:_____________________________ HM
Ph:________________WK Ph:____________________
NAME OF
PARENT/GUARDIAN_______________________________________________________________
EMERGENCY
CONTACT_____________________________________PHONE_________________________
HT:_________ WT:________
HT:_________ WT:________ HT:_________
WT:________
Hobbies/Interest:_______________________________________________________________________________
If a student, what grade and school do
you attend:_______________________________________________________
ANY PHYSICAL LIMITATIONS, HEALTH
PROBLEMS, MEDICATION REQUIREMENTS, INJURIES
____________________________________________________________________________________
PREVIOUS MARTIAL ART
TRAINING___________________________________________________________
HIGHEST RANK ACHIEVED______________________________LENGTH OF
TRAINING___________________
Date Enrolled in this
Class:_____________________________________Uniform and or Belt
Size:________________
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CHECK ALL AREAS OF INTEREST: EXERCISE _____ DISCIPLINE_____
SELF-DEFENSE____
SPORT_____
COMPETITION____
SELF-IMPROVEMENT____
ADVANCING MA BACKGROUND____
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Please check the one that applies: I am enrolling at the YMCA____ Triple T’s______
The above information is required for the
purpose of my record maintenance on student's history, progress reports and for
preparing certificates of training. I
will keep all information in strictest confidence.
Thank
you....Instructor Wayne
Spencer