Robert Jones EAST WEST INTERNATIONAL BLACK BELT ACADEMY
Application for Admission
Student NameSexAgeBirth Date
Responsible Party Name
Address City Zip Code
Telephone Height WeightMarital Status
Employer Occupation Telephone#
School (if for child) Grade Level Teacher
How did you come to our website? Have you ever studied before?
If yes, Which Art? How Long?Rank Obtained
How long have you wanted to study the martial arts?
How long have you lived in the area? Can you attend two classes per week? Yes No
Will you be living in the area for the next year? Yes No