New Student Quick Registration
Please complete and submit this form to enroll in classes. Payment for class may be made by check at your first class. Your uniform will be issued at time of payment.
Today's Date:
Select Program: *	Team Turtle (4-6yrs old) Jr. Kicks (6-15 yrs old) Adult (16 & up)
Student's Last Name: *
Student's First Name *
Parent's Last Name: *
Parent's First Name: *
E-mail: *
Home Phone: *
Cell Phone: *
Address: *
City: *
State: *	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip code: *
Student's Birthdate: *	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Student's Gender: *	Male Female
Student's Height: *
Student's Weight: *
Have you studied martial arts before: *	yes no
If "yes" describe your previous experience:
Medical Restrictions:
Describe any medical restrictions or health issues:
How did you hear about us? (Check all that apply)	Friend / Family member CALELITE Member Mailed Coupon Google Search Yahoo! Search Other Search Engine School Flyer Website Yellow Pages Other
Other:
If you checked more than one source, which was the most influential in your decision to visit us?	Friend / Family member CALELITE Member Mailed Coupon Google Search Yahoo! Search Other Search Engine School Flyer Website Yellow Pages Other
Additional Comments: