CALL US (09) 816 8649 now for
1
free lesson!
HOME
About
Sifu Quintin Derham
Instructors
Testimonials
Classes
Children Kempo
Youth Kempo
Adult Kempo
Tai Chi & Qigong
Self Defence
Kerikeri Kempo & Tai Chi School
Enrol
New Children Kempo questionnaire
New student Tai Chi questionnaire
New adult Kempo questionnaire
Student Info
Timetables
Events
Downloads
Uniform
Grading
My Dojo
>
What is My Dojo
Blog
Free Trial
Online Courses
Tai Chi DVD
Contact
New Adult Kempo questionnaire
We like to know a little more about you, the additional information you provide will help us recommend the best programme/class for you.
*
Indicates required field
Name
*
First
Last
Address
*
Age
*
Phone / Mobile Number
*
Email
*
Have you practised Martial Arts? If yes please name style/organisation -
*
What would you like to learn or improve whilst learning Shaolin Kempo?
*
Self Defence
Fitness
Weight loss
Muscle tone
Mindful exercise
Relaxation
Energy flow
Weaponry
Injury/accident recovery
Strengthen spine
Balance & stability
We can also provide online lessons to support your learning and DVD's, are you interested in learning online?
*
Please advise best days and times for classes
*
Please inform us if you have any medical conditions we should know about
*
Thank you for taking the time to complete this form.
All information completed on this form will be kept private and confidential.
Submit
