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Wu Dang Kung Fu Academy – New Student Registration Form

1. Student Information

Date of Birth (MM/DD/YYYY):
Month
Day
Year
Gender:
Male
Female


2. Parent/Guardian Information (if student is under 18)



3. Program Selection

Please check one or more:

Kung Fu Programs
Boxing & Sparring Programs
Preferred Class Time:


4. Emergency & Health Information

Emergency Contact

Consent for Emergency Medical Treatment:
Yes
No


5. Waiver & Consent

I understand that martial arts training involves physical activity and assume all risks related to participation. I agree that Wu Dang Kung Fu Academy, its instructors, and staff are not liable for any injuries or accidents that may occur during classes, training, or related activities.

I give consent for photos/videos taken during classes or events to be used for academy promotions.


6. Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Date:
Month
Day
Year
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Date:
Month
Day
Year
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