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Soja Martial Arts & Yoga Registration
#1 Student:
Male
Female
Age:
Date of Birth
:
#2 Student:
Male
Female
Age:
Date of Birth
:
Parent/Guardian:
Home:
Work:
Call first in case of emergency
Parent/Guardian:
Home:
Work:
Call first in case of emergency
Email: (Soja does not share mailing lists or e-mail addresses)
Cell:
Cell:
Address/City/Zip:
Emergency Contact other than above numbers: To be used if first two parents/guardians indicated above cannot be reached.
Telephone
Medical Doctor:
Telephone
Student Special Needs:
Please explain if you or your child has any special physical, behavioral, learning, or medical needs.
List all serious
allegies. Attach additional sheet if necessary.
Soja Martial Arts & Yoga Registration
How did you hear about us?
Please list history of any martial arts programs you or your child has already participated in. Also, please list class(es) student is enrolled in (which day school, and any other martial arts or other physical education programs outside of their daily school)
S
o
ja Mind/Body Kung Fu
2406 Webster St., Oakland, CA 94612, 510.832.7652
www.SojaMaritalArts.com
,
info@SojaMaritalArts.com
