after trial class form
Student's First Name
*
Student's Last Name
*
Email
*
Based on what you have seen so far, what has impressed you the most?
Why is that important to you?
Do you feel that your significant other would support your decision in getting in shape and learning self - defense?
Yes
No
What has prevented you from getting started in a program in the past?
Based on everything we have discussed, do you feel we have something that you can benefit from and would like to continue to learn?
Is that still a problem?
Yes
No
Is there anything that would prevent you from getting started in a program today?
SUBMIT
