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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
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First
Last
Address
*
Age
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Phone / Mobile Number
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Email
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Have you practised Martial Arts? If yes please name style/organisation -
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What would you like to learn or improve whilst learning Shaolin Kempo?
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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.
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