Twin Dragon Kung Fu Academy


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*Student's First Name:
*Student's Last Name:
*Home Telephone Number:
*Cell Phone:
*Parent Name:
*Other Contact:
** Email is for internal use only: newsletters/announcements
*Date of Birth: (MM/DD/YYYY)
*Sex: Female   Male
*Have you had any prior experience with Martial Arts? If so, what style
and what rank did you attain?
*What is your goal for you or your child while at
Twin Dragon Kung Fu Academy?
*How did you hear about Twin Dragon Academy? Friend     flyer/Advertisement
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Twin Dragon Academy reserves the right to dismiss any student at any time for action(s) which may convey a negative image of this studio or of our Martial Arts philisophy. Twin Dragon Academy is a drug free environment and we operate under a No Tolerance Policy concerning the illegal use of drugs/alcohol. Monthly tuition payments must be turned in on or before the 25th for the following month. Payments received after the 25th will result in a $10 late fee; payment received after the 1st of the month will result ina $25 late fee and the student will not be able to participate in classes. Our studio is a month to month contract and we require a 30 day notice in writing for disenrollment.

I, the undersigned, hereby agree that Twin dragon Academy will not be held responsible for any injuries occurring on the premises. Furthermore, I take full responsibility for all medical expenses incurred in case of injuries.

(Please note that you will be required to come to the office in person in order to sign this document and complete the registration. Persons younger than 18 years of age require a parent or guardian to sign.)