RSA Aina Haina Kids Jiu-Jitsu Application
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Child's Name
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Child's Age
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Parent's Full Name
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Parent's Email
(Your e-mail will be kept confidential and used for your application purposes only)
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Parent's Phone Number
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Where on Oahu do you reside?
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How long do you plan on living on Oahu?
Under 1 Year
1 Year
2 Years
3 Years
4 Years +
Forever
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Is your child in good health?
Yes
No
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Select the sports your child participated in:
Brazilian Jiu-Jitsu
Wrestling
Judo
Striking Arts
Other
None
If applicable, please name previous Jiu-Jitsu school?
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What rank has your child attained?
None, still novice
Yellow
Orange
Green
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Why do you want your child to learn Gracie Jiu-Jitsu?
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What made you choose the RSA academy?
How did you find out about us?
Internet search "Gracie Jiu-Jitsu"
Internet search "Martial Arts"
Internet browsing
A family member
A friend
Other
If referred, who may we thank for your visit?
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Indicates Response Required