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KENTUCKY CAPOEIRA ACADEMY

Dance. Fight. Game.

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Interest Form

YOUR FIRST NAME*

YOUR LAST NAME*

Email*

Age

Phone*

How many will attend?*

Multi-line address

Country/Region

Address

City

Zip / Postal code

Are you registering as the a parent or guardian of a child(ern)?*

Yes

How did you about Kentucky Capoeira Academy?

What prompted your visit?

How long have you or your child(ern) wanted to learn a martial art?

Do you or your child(ern) participate in any other physical activity?*

Which of these statements applies to you or or child(ern)?

I would like myself or my child(ren) to have the confidence to know how to resolve conflict without resulting in violence.

I would like my self or my child(ren) to develop a sound personal conduct that can be attained from good martial arts instruction.

I would like myself or my child(ren) to get into an exercise program that will promote lifelong healthy habits.

I would like myself or my child(ren) to develop better concentration and focus for school and other activities.

I would like myself or my child(ren) to know how to effectively respond in a dangerous situation.

Please check all that apply:

I would like the confidence to know I could take care of myself in a dangerous situation.

I'm looking for a hobby for myself or my child(ren).

I would like myself or my child(ren) to get into and stay in better shape.

Is this your first time attending?*

Yes

5 PRINCIPOIS DA CAPOEIRA:

Obediência

Honora

Expressão

Benevolência

Proteção

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