AIKIDO Classes Registration Form

Please registered with participant name & sign a waiver form before starting any activity in the dojo.

Thank you. 

First name:

Last name:

Date of birth:

Gender:

E-mail:

Mobile:

Address:

City:

State:

ZIP:

Preferred method of contact:

Emergency Contact Name:

Emergency Contact relationship:

Emergency Contact phone:

Do you have any health challenges/concern we should know about eg. asthma, allergies, or any other medical condition or physical disabilities?::

Do you have any martial arts experience? What style? Number of years trained? :

What are your expectation from us? :
Class: