Klein's Black Belt Academy, All Rights Reserved.
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 at  
contact@blackbeltacademyinfo.com
Register Now
NEW 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):
Class interested in:
New Student Special (Begins June 26th)
Tiny Tigers         (Ages 4-6)             Mon 6:15pm, Wed 6:15pm
Karate for Kids (Ages 7-14)          Mon 6:45pm, Wed 6:45pm
Date you plan to stop by:
Please check the Calendar area to
make sure there are no special events
on the day you plan to stop.
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: