Student Registration – Miamitown Martial Arts Ministry

Miamitown Martial Arts Ministry

Contact Info: Adult Student OR Parent/Guardian of Under 18 Students

*Name:

*Phone/Cell #:
This is a cell phone and I can receive texts

*Email:

*Emergency Contact: *Phone/Cell #:

Student #1 Information

Name:
Birthday: Age: Date of First Class:

To determine Uniform/Belt size:

Height

Weight:

OR

Uniform Size: Belt Size:

Student #2 Information

Name:
Birthday: Age: Date of First Class:

To determine Uniform/Belt size:

Height

Weight:

OR

Uniform Size: Belt Size:

Student #3 Information

Name:
Birthday: Age: Date of First Class:

To determine Uniform/Belt size:

Height

Weight:

OR

Uniform Size: Belt Size:

Student #4 Information

Name:
Birthday: Age: Date of First Class:

To determine Uniform/Belt size:

Height

Weight:

OR

Uniform Size: Belt Size:

Anything extra we should know? (optional)

To guard against spam crawlers can you answer the following question in order to send?

What color is NOT on the Korean flag, red, white, blue, black, or pink?