Ultimate Success Karate Promotion Registration Form

Student Name *

Parent Cell phone *

Parent email *

Promotion Date *

Parent/Student - Instructor Progress Report

In what areas of yours (or your child's life have you noticed improvements and progress because of the martial arts *

What areas of yours (or your child's life would you like to see more improvements? *

Any ways in which we could make your experience better here? *

For school age students only:

What academic school does your child go to?

Often, we visit schools for our popular free 'school talks" designed to reinforce life-skills such as Respect, Anti-Bullying & Stranger Awareness. Would it be ok if we contact your child's teacher to introduce him/her to our school talks?

YES/NO

YES

Please provide teacher's phone # and or email:

What is your child's teacher name?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.