Please fill in all fields that apply to you and then click submit:


High School or College Name: Student Level: Freshman Sophomore Junior Senior

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*First Name: *Last Name: *Gender: Male Female

*Home Address: Apt #:

*City: State:

*Home Phone Number: (no dashes)

*Email Address:

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*Program : Jiu Jitsu - Teenager Jiu Jitsu - Adult York High School Special - BOYS York High School Special- GIRLS Summer Camp 2008 - GIRLS Summer Camp 2008 - BOYS uicFIT uicDEFENSE

Describe your level of fitness: Poor - limited/no exercise Moderate - exercise 1-2 times per week Good - exercise 2-4 times per week Excellent - exercise 4+ times per week

List the activities that you do (e.g. tennis, wrestling):

*How did you hear about us:

Given the benefits of our programs, we get a lot of father-son, mother-daughter, and sibling sign-ups. Please list the names of any family members that are interested in our programs (we have a special discount program for them):

Thank You!