Devore Academy of Martial Arts
QUICKSTART Application Form
Who are the lessons for (name):
For You or Family Member?:
For myself
My Child
My Spouse
Family Member
My Grandchild
What program?
Please select...
Little Ninjas (ages 3 - 5)
Juniors (ages 6 - 13)
Adult Only Programs (ages 14+)
Family Karate (all rank, all ages)
Your Phone Number:
Your Email Address:
If Child, Parent's Name:
What benefits are you looking for?
Stress Reduction
Muscle Tone
Endurance
Mental Focus
Respect for Self and Others
Improved Behavior
Self-Esteem
Assertiveness
Weight Control
Strength and Flexibility
Concentration
Self-Control
Self-Discipline
Confidence
Self-Defense
Physical Fitness
What time would you like to schedule your first lesson?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Call me to schedule