Schedule a Free Class | Black Belt Institute

TRY AFREE CLASS!

Discover confidence, discipline and a stronger tomorrow.

WHO IS TRAINING?

Tell us who will be taking class. We'll use age to show the right beginner program.

Student First NameStudent Last Name

Student's Date of Birth

CHOOSE YOUR FREE CLASS

LIL' DRAGONSAGES 3½–6

Confidence • Focus • Coordination • Fun

Need a different time? Call us at (732) 205-9797 and we'll help you find a class that works.

TELL US ABOUT YOUR FAMILY

PARENT / GUARDIAN INFORMATION

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STUDENT QUESTIONNAIRE

Please tell us a little more about the student before their first class.

1) CHECK YOUR MAJOR REASONS FOR LEARNING MARTIAL ARTS.

Choose all that apply, then select the most important.

Most important reason 2) How did you hear about Black Belt Institute? 3) Will you be living in this area for at least a year? 4) Can you commit to at least 15 minutes per day at home practice? 5) Do you have any medical/physical conditions (such as past surgery, joint discomfort, or chronic pain) which may effect your physical training? Explain 6) Please list any medications you are taking: 7) Have you studied any type of Martial Arts before?Style (if applicable) 8) For acceptance into our program are you prepared to follow the rules and Philosophy of the Martial Arts discipline and set goals for mental and physical fitness? 9) If you are in school, what is your grade average? 10) Our academic policy for a young Black Belt is an “B” average or better. Are you prepared to fulfill this goal if not already there?

PARENT/GUARDIAN LIABILITY AGREEMENT

Please review the agreement below before signing.

BLACK BELT INSTITUTE

I agree that Black Belt Institute, the School, will not be liable for any injuries, damages or harm I may suffer as the result of my participation in the training and course or any other activity connected with the School, except for damage, injury or harm arising directly from the negligence of the School or its owners, operators, agents, servants or employees.

I have read and agree to the above.Parent / Guardian Signature

By typing your full legal name and selecting Complete Registration, you are electronically signing the agreement above.

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YOU'RE SCHEDULED!

A confirmation will be sent to . If you need to cancel or reschedule, please call us at (732) 205-9797.