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 level is the most suitable for your child. * Level 1 ( age 5 to 9) Tuesday & Thursday 5pm Level 2 ( age 10 to 14) Tuesday 6pm & Saturday 10am Level 3 competition team Thursday 6pm TRIAL CLASS DATE HERE * MM DD YYYY Thanks for submitting your application. We look forward to seeing you in class.
