Registration Form

Please provide the information with the best of your knowledge.

The fields with the red asterisk * are required.
 
* Last Name :
* First Name :
* Date of Birth (mm/dd/year) :
   Gender : F M
* E-mail Address:
* Confirm your E-mail :
* Address:
* City:
* State:
* Zip:
* Home Phone:
   Cell Phone:
   Occupation:
   Work Phone :
   Father's Name
   (Guardian's Name):
  Phone:
   Mother's Name
   (Guardian's Name):
  Phone:

Emergency Contacts
* Name :   * Phone:
* Name :   * Phone:
* Doctor's name:   * Phone:
* Insurance Plan:

Health issue. If yes, explain
       
Tell us how many classes you like to take per week. 1        2       3        
Summer Intensive Program
     
Payment method

I, as the parent/guardian of the above named student(s), hereby state that I have read these documents published on web http://www.winwinkungfu.com/regi.htm.
  • I have read and agreed to “Accident Liability Waiver Agreement”, “Enrollment Policies”, and “Registration Process”.
* I agree          * Parent/Guardian Name  


Any Questions?


       

Online Documents

Accident Liability Waiver Agreement”

Enrollment Policies

Registration Process


Contact Us:

Phone:
412-336-8898
412-206-1130

Email:
masters@winwinkungfu.com