School Age Personal Analysis Questionnaire
Date
/
Month
/
Day
Year
1
How did you find out about us?
*
Facebook
Google Search
Friend/Family member
Signage (driving or walking past)
Radio Ad
Other
Child Name
First Name
Last Name
Age
DOB
*
-
Day
-
Month
Year
2
Address
*
Street Address
Town/City
State
Postcode
Parent/Responsible 1
First Name
Last Name
Email
*
example@example.com
Phone
*
Parent/Responsible 2
First Name
Last Name
Email
example@example.com
Phone
When did you first become interested in getting your child into martial arts?
*
Whose idea was our martial arts program?
*
You
Your child
Both
Do you encourage your child to set goals and follow through on those goals?
*
Yes
No
Are you willing to have patience in getting the results you want?
*
Yes
No
As a parent, are you willing to support your child in their progress and leave the critical feedback up to the teachers?
*
Yes
No
Parent/Carer Sign
*
Date Signed
/
Day
/
Month
Year
3
Submit
Should be Empty: