Registration does not automatically guaranty enrollment.  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's First Name
Student's Last Name
Student Birthday
MM/DD/YYYY
Parent/Guardian Name
(if applicable)
Phone number
Email address
Session  (Sept 25th - Dec 9th)
Choose one day/time from list below
Kids  (Ages 4-6) - New Students & White/Orange/Yellow Belts
O
Mon/Wed 5:45-6:15pm (CLOSED - CLASS FULL)
O
Tuesdays 5:45-6:25pm (CLOSED - CLASS FULL)
Kids  (Ages 7-14) - New Students & White/Orange/Yellow Belts
Mon/Wed 6:15-6:45pm (New Students & White/Orange/Yellow Belts)
Tuesdays 6:25-7:05pm (New Students & White/Orange/Yellow Belts)
Returning Students ONLY
Mon/Wed 5:15-5:45pm   (Black Belts)
Mon/Wed 6:45-7:15pm   (Camo/Green/Rec Purple)
Mon/Wed 7:15-7:45pm   (Dec Purple - Rec Black)
Tuesdays 7:05-7:45pm   (Camo - Rec Black) Combined Middle/High Rank Class
Adults/Teens  (Ages 14+)
Krav Maga   - Mondays (Optional Wednesdays)  7:45-8:30pm
Taekwondo - Tuesdays 7:45-8:25pm
Martial Arts Wellness Center • Burlington, Wisconsin • (262) 758-3378
Email Us • http://www.BlackBeltAcademyInfo.com/
Martial Arts Wellness Center, All Rights Reserved.
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