Signing up for classes is now even easier.  Just submit the below registration.  If you have any questions, please
call (262) 758-3378.  If we're not available please leave a message and someone will return your call as soon as
possible.  You can also EMAIL US.
Getting Started
STUDENT REGISTRATION
Please note that registration does not automatically guaranty enrollment.  Minimum student class sizes are required.  
Classes fill up on a first come first serve basis.  Spots are only held once payment is received.  Fill out a separate
registration for each student.
Student Information:
Name (First and Last):
Birthday (MM/DD/YYYY):
Program registering for:
Winter Session (Dec 5 - February 29)
Kids   (Ages 4-6)            Mon/Wed 6:15pm
Kids  (Ages 7-14)          Mon/Wed 6:45pm
Adults  (Ages 15+)       Mon/Wed 8:30pm
Minimum Enrollment Required to hold Adult class
If student is under 18 years old:
Your Name:
Relationship
to Student:
Contact Information:
Address:
City:
State
 Zip:
Email address:
Phone number:
What aspects of martial arts are you interested in?
Self-confidence
 Confidence
 Family Activity
Self-defense
 Concentration
 Fitness
Coordination
 Discipline
 Stress Relief
Other (please list):
How did you hear about us:
Friend/Family
 School Flyer
 Sign/Banner
Poster
 Web site
Other (please list):
Additional Comments/Questions:
Martial Arts Wellness Center • Burlington, Wisconsin • (262) 758-3378
Email Us • http://www.BlackBeltAcademyInfo.com/
Martial Arts Wellness Center, All Rights Reserved.