Enroll for Your Guest Class Your Guest Class is FREE. It's your chance to know us better and to experience Martial Art practice with us. It's our chance to know you better. Together we can decide "if we're a fit". Please Tell Us About Yourself. Today's Date * I am interested in the following program(s) * Taekwondo     Hapkido     Kimoodo     Gumdo Student's Last Name * First Name * Gender * Male     Female If Student is minor, Parent/Guardian Name; or "NA" * Street Address * City * State * Zip Code * Primary Phone # * Primary E-mail * Date of Birth * Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Age School Attending Grade Level University Attending Major Course of Study Occupation Have you practiced Martial Arts before * Yes     No If "Yes", please tell us about your practice: Which Art? How long? Where? Instructor? Rank achieved? Why discontinued? What is your motivation to study Martial Arts? Check all that apply. * Self Defense Physical Exercise Self Improvement Family Activity Enjoyment How did you learn about Dayton Area Taekwondo? Check all that apply. * Self Referred Referral by Current Member Web Site Public Event Mail Ad Newspaper Ad News Article I would like to come in when class is in session so I can ... * Take a GUEST CLASS     Observe Please schedule me for this day. * Monday Tuesday Wednesday Thursday Friday ................. on this date * .................. at this time * 12:00 Noon 5:30 p.m. WAIVER ­ I understand that with every physical activity there is some risk of injury. I agree to waive all claims against any person/s connected with any and all programs for injuries I may sustain and I likewise assume full responsibility for all my actions in connection with all said programs. I understand there are rules and regulations associated with these programs and I will abide by said rules and regulations. I give permission for the instructor in charge or his designee to summon professional medical assistance if necessary on my behalf. I also understand that any pictures and video of me participating in said programs may be used without any compensation. I have read, I understand, and I ACCEPT the above WAIVER. Enter your Name in the Box. MUST BE 18 yrs. of age or older. * Enter these letters/numbers in the box. * NOTE: This form does not retain information. If you would like copy, please PRINT before you press "Submit".