Martial Arts Registration Form

Please fill out the following information to register you or your family for our martial arts program:

Family or Student Name*

Name(s) and Age(s) of (Family) Member(s)

Address*

Address 2

City, State, Zip*

Phone*

eMail Address*

Emergency Contact Name

Emergency Contact Phone

Please list all allergies / medical conditions (if none, type N/A)

Agreement

Electronic Signature*

(If under 18 Electronic Signature of parent/guardian)

Captcha

(734) 447-3000 main

(734) 365-6925 call/text

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Plymouth, MI

13101 Eckles Rd. Suite 209

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Domo arigato