Online Application Form

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Online Application Form
Lion dance Application Form

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Online Application

Please fill out our online application to schedule your screening appointment today!

Application

Name

Phone

Confirm Email:

Date of birth:

Address:

Which programs are you interested in? :

Children's Program (Little Dragons)

Pupil Program

Disciple Program

One-on-One Instruction

Shaolin Lohan Pai Lion Dance Troup

Which location are you interested in? :

Springfield, MO (Taking Applications)

Honolulu, HI (Taking Applications)

St. Louis, MO

What is your class availability? (Check all that apply) :

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Have you had any martial art experience? (Check all that apply):

Kung Fu

Tai Chi

Kenpo

Karate

Judo

Jiu Jitsu

Tae Kwon Do

Aikido

MMA

Other

No previous experience

How did you hear about us?

Pupil referral

Disciple referral

Internet

Yellow pages/print

Other

Additional Comments

Requested date & time for interview/screening:

I certify that I am at least 18 years old, and I understand that I may be required to provide my social security # at the time of my interview.

Yes

Thank you for contacting us.
We will get back to you as soon as possible

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a b c d e f g h i j k l m n o - Do not remove from template!!! it is important to support different fonts

+417 365 0326

ShaolinLohanInfo@gmail.com

2135 E. Independence #1012 Springfield, MO 65804

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