Kids trial class form Name * First Name Last Name D.O.B * MM DD YYYY Medical Questionary If your answer is 'yes' to any of the following questions please check the box. History of heart problem, chest pain or stroke? High blood pressure? Any chronic illness or condition? Recent surgery in the pass 12 months ? History of breathing or lung problems? Muscle, joint or back disorder, or any previous injury still affecting you? Diabetes or thyroid conditioning ? Name ( Parent Guardian ) * First Name Last Name Phone (###) ### #### Email * How did you hear about us? Google Instagram Friend Walking by PLEASE CHOOSE WHAT DAY YOU WISH YOUR CHILD TO ATTED THE TRIAL CLASS. Class Timetable: level 1: Tuesday & Thursday 5pm (age 5 and above) Level 2: Thursday 6pm & Saturday 10am (age 10 and above) TRIAL CLASS DATE HERE MM DD YYYY Thanks for submitting your application. We are looking forward to seen you in class.
