REGISTRATION – STEP 1

Parent / Guardian Name*

Relationship to Student*

Email Address*

Phone Number*

Address*

How did you hear about us?* Select... Instagram Facebook Google Search Website Friend or Family School Therapist / OT / Speech Step Up for Students Saw the Studio Flyer Other

Which program are you most interested in right now?* Select... Starter Journey ($75) — Recommended Start Standard Youth Program (Ages 7–16) Adaptive Martial Arts (Autism/ADHD/Sensory Needs) PTC Competition Team (Add-on / Invite Only) Women’s Kickboxing (17+) Adult Kung Fu (17+) Not Sure — I’d like a recommendation Tip: New youth students usually begin with the Starter Journey so I can recommend the right pathway.

Does your child have any support needs we should be aware of? (Optional) Select... None ADHD Autism Sensory Sensitivity Physical Limitations Other / Prefer to discuss

Are you using Step Up for Students?* Select... No Yes Not Sure

Preferred contact method* Select... Text Phone Call Email

Best time to contact you (Optional) Select... Morning Afternoon Evening

Consent to receive texts/emails about scheduling and enrollment* Select... Yes No We only use this for studio communication. You can opt out anytime.