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Enrollment Application
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Name
*
First
Last
Birthday
*
Mobile Phone
*
Email Address
*
GOALS & BACKGROUND
What are your goals through training with us?
Why do you feel martial arts is the way to achieve your goals?
What have you tried before to reach your goal?
What held you back from continuing with that?
What's going to prevent you from quitting this program?
GETTING TO KNOW YOU
How would you rate yourself in the following areas?
*Move each slider to the appropriate rating. Rating is as follows: 1- Strongly Disagree, 2- Disagree, 3- Neutral, 4- Agree, 5- Strongly Agree.
I have strong self-esteem.
Selected Value:
0
I am at a healthy weight.
Selected Value:
0
My stress level is low.
Selected Value:
0
I don't need to physically defend myself.
Selected Value:
0
I'm confident I could physically defend myself.
Selected Value:
0
I have great supportive friends.
Selected Value:
0
I am living a healthy lifestyle.
Selected Value:
0
What benefits of martial arts training are most important to you?
Improved Self-Esteem
Weight Loss
Stress Relief
Self-Defense
Making Friends
Increased Fitness
Other
What do you think is your biggest obstacle preventing you from accomplishing your goal?
Is there anything else you think would hold you back?
How is this goal impacting your day to day life?
What would be different if you achieve your goals?
Where do you want to be a year from now?
Are you currently doing anything else to help you reach your goals?
HOW DID YOU HEAR ABOUT US?
How long have you lived in the area? (Make a selection from dropdown menu.)
0 - 3 months
6 - 12 months
1 - 2 years
3 - 4 years
5+ years
Will you be living in the area for at least one year?
How did you hear about us?
Do you know anyone who trains here?
What are your top factors for choosing GFKA?
Quality of instruction
Personal attention given in class
Reputation
Curriculum
Location
Facility
Atmosphere
Other
LAST FEW QUESTIONS!
Are you in good health and physical condition to begin a training program?
Are you willing to adhere to the principles of our program, including enforcing the personal expectations within by holding yourself accountable to your actions?
Are you willing to commit time outside of class (15-30 minutes daily) to put into practice what you learn?
THANK YOU!
We greatly appreciate your interest in our programs at Glens Falls Karate Academy. Upon submitting your application, our admissions staff will review your survey and reach out to you with any further questions or next steps for setting up your first visit! Keep an eye on your email (the address provided earlier) for a confirmation that we've received your application as well as an outline of the remainder of our enrollment process.
If there is any other information you wish to provide, or questions you'd like to discuss when we call, please feel free to add them below:
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