Douglas Family Registration

FAMILY REGISTRATION FORM

If you ever need to make changes your payment method or plan, you can do so in the Customer Account area.

Before the first class, we need some information about EACH PERSON who is coming with you.

New Student Info - Family

Family Information
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Emergency Contact Information
Name
First Last
Relationship*
Emergency Contact Phone*
- Student #1 Information
- Student #1 Name*
  First Last
- DOB*
  Month
  Day
  Year
- Age*
- Email*
- Do you have prior military service? If yes, what branch and MOS, number of.years served?
- Do you have martial arts background? If yes, what style and how many years?
- Any medical problems or injuries we should be aware of?
- Student #2 Information
- Student #2 Name*
  First Last
- DOB*
  Month
  Day
  Year
- Age*
- Email*
- Do you have prior military service? If yes, what branch and MOS, number of.years served?
- Do you have martial arts background? If yes, what style and how many years?
- Any medical problems or injuries we should be aware of?
- Student #3 Information
- Student #3 Name*
  First Last
- DOB*
  Month
  Day
  Year
- Age*
- Email*
- Do you have prior military service? If yes, what branch and MOS, number of.years served?
- Do you have martial arts background? If yes, what style and how many years?
- Any medical problems or injuries we should be aware of?
- Student #4 Information
- Student #4 Name*
  First Last
- DOB*
  Month
  Day
  Year
- Age*
- Email*
- Do you have prior military service? If yes, what branch and MOS, number of.years served?
- Do you have martial arts background? If yes, what style and how many years?
- Any medical problems or injuries we should be aware of?

FAMILY REGISTRATION FORM

New Student Info - Family

Student #1 Information

Student #2 Information

Student #3 Information

Student #4 Information