Rogue Martial Arts Academy Enrollment Request

If you would like to enroll with Rogue please complete the form below or visit us to complete the form in person.

Please note that if you complete the online form below you will need to bring your payment information with you to your first class. All payments are pre-authorized (monthly) and can be made by credit card or debit.

Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Date of Birth

YYYY

Current Age

Gender

MCP

Address

Emergency Contact Name

Emergency Contact Phone Number

(###)

###

####

Do you have any prior martial arts experience?

If yes, please explain

Do you have any allergies?

If yes, please explain

Class options

Membership type

Hybrid TKD Classes

all fees below will be charged monthly and are subject to HST

Kickboxing Classes

all fees below will be charged monthly and are subject to HST

MMA Classes

all fees below will be charged monthly and are subject to HST

Requested Start Date

YYYY

Parent/Guardian

Are you completing this form as a parent or guardian?

Yes

Agreement

By selecting the box below you agree that all information listed is correct and that we may contact you regarding your enrollment with Rogue Martial Arts Academy.

Yes, I Agree

Rogue Martial Arts Academy Enrollment Request

Are you a Rogue?