Name *

First Name

Last Name

What are your goals for martial arts training?

Build Confidence

Self-defense

Physical Fitness

Mental Clarity

Improved Self-discipline

Stress Management

Skill Refinement

Social Experiences

Other

What best describes you?

No martial arts experience

Practiced a long time ago

Trained on and off for years

Competed and want to return

Trained but had a negative experience

Currently training but looking for something different

Which age range best describes you?

13-17

18-35

35-45

45-55

55-65

65+

What best describes your experience with physical altercations?

I've never been in a fight

Typical playground fights

I have been attacked in the past

I have been in several altercations

No comment

What is your opinion of traditional martial arts (eg: uniforms, customs, forms, etc.)?

I don't know much about it

I have no opinon

I am curious

I have always been fascinated

I'd like to know more history

I'm a little intimidated

I'm not interested

I don't think it's necessary

What are your concerns for starting martial arts?

Age

Past injuries

Physical condition

Time commitment

Cost

Other

Which of the following do you recognize or have experience in?

Karate

Kung fu

Jiu jitsu

Judo

Tae Kwon Do

Muay Thai

MMA

Wrestling

FMA

Other

How strong is your interest in starting martial arts?

Ready to start

I have questions

Still looking for a school

I'm just curious