Warrior Spirit Martial Arts Academy,
                             Application for Admission


Student Name Sex Age   Birth Date   

 Height Weight   Address     City   

Zip Code   Telephone

School (if for Child)   Grade Level  Teacher

Responsible Party Name   
 Physical Fitness  Self Control Self Esteem
 Coordination  Strength to say "NO" Competition
 Improve Grades  Greater Energy   Flexibility
 Weight Control  Self Discipline  Respect for Others
 Self Confidence  Meet New People  Recreation
 Stress Management  Self Defense  Endurance
How did you hear about us/come to our Website    

Have you ever studied before          How long have you lived in the area     

Can you attend 2 Classes per week?     Will you be living in the area for the next year? 

Student or his Parents acknowledges the existence of the potential for personal injury in participating in a course of instruction in an a course of instruction in an activity such as Wu Shen Pai Kenpo and that he or she, in consideration of being admitted to Warrior Spirit Martial Arts Academy, is assuming this risk without liability to this school or its instructors, assigns, employees, etc. by executing this agreement and participating in this course of instruction