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Choose your trial option*
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Your full name*
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Phone*
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Email address*
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Your relationship with student*
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Student's full name
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Student's age*
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Any prior martial arts experience?*
If yes, please tell us about it.
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Program that you are interested in*
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Benefit that your are interest in*
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Parent/Guardian Name*
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Email*
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Phone
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Child Name
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Age
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Please rate your child on a scale from 0-10 where 0 is the least confident and 10 is the most confident from the following tasks.
Please take a few minutes to tell us about your child so that we may best serve you.
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My child is able to make eye contact.
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My child is able to follow simple directions.
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My child can engage well with other children in a classroom setting.
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My child can be calm in a learning situation.
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My child responds positively to music.
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My child likes physical movement.
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My child likes to play.
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Which of the following abilities would you like to see progress in your child?*
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What other ideas, concerns or questions do you have for us?
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