Appointment Request and Intake Form

First Name(required)

Last Name(required)

Email(required)

Phone(required)

Any Prior Martial Arts Training?(required)

I do not have any prior martial arts training I have prior martial arts training

Please describe any prior training style(s), ranks, and achievements

My goals are (choose as many as apply):(required)

Lose weight Get in better shape Learn about Japanese culture, traditions, and philosophies Be part of a community Restart martial arts training Learn something new Learn to defend myself

Please share any other goals not stated above:

Physical Limitations(required)

I do not have any physical limitations I have physical limitations

Please describe any physical limitations that could hinder your training:

We want you to come and have a great first visit with us and address any questions or concerns you might have. Membership at Yaoki Martial Arts is semi-private so all prospective students will be on a free one month trial period. This trial period is a great opportunity to get to know us, our philosophies, training style, and our source material. This trial period is risk and obligation free, and you are not obligated to stay the whole time if at any point during the month you decide Yaoki Martial Arts isn’t for you. The head instructor will also assess how well you fit in to the group, adapt to the training, and etc. She will make a determination to accept you, or not, as a student at the end of the trial period.

Choose one(required)

I understand and agree to the one month trial period I do not understand the one month trial period and would like more information

I'd like to visit on:(required)

Tuesday Evening at 7:45-9:00 PM Saturday Morning at 9:00-10:45 AM

Please pick a Tuesday or Saturday Date for your first visit:(required)

I'd like to:(required)

Participate in class for my first visit Observe the class for my first visit