Student Information Sheet

Admin Use: Card___SCS___BD___MLCMP___EEI___AG___EXT___
Please complete:
Student's Name *
Student's Name
Address
Address
Birth Date
Birth Date
Parents Name
Parents Name
Please list both parents in "First Name"
Separated? (please check off)
Phone
Phone
Emergency Contact
Emergency Contact
Emergency Phone
Emergency Phone
Interests
What are the main benefits you/your child hope to gain from Martial Arts/Cardio training? (check all that apply)
How did you hear about us?
Who can we thank for your referral?
Who can we thank for your referral?
Medical Release
List or "none"
Please initial as e-signature.
I understand the above. *
Do you have? (please check if it applies) *
List or "none"
List or "none"
Are you/could you be pregnant? *
Photo Release
Please initial as e-signature.
Photo Release *

Oak Ridge Martial Arts Academy

"the finest in martial arts training."