Test From | nzwushu

First name

Last name

Phone

Email

Address

Date of Birth

Day

Month

Year

Name of Parent / Guardian (if student under 18 years old):

Emergency contact if different from above (name & number):

I would like to:

Attend a free trial class

Enrol in a class

Free Trial Date:

Previous wushu or other martial arts experience:

Enter Promotion Code if you have one:

If word of mouth, please write down the referrer's name so that we may thank them:

Are there any medical conditions we should be aware of, or do you have any other comments?

Please be aware that occasionally we may use videos and photos, etc of our students in NZ Wushu Academy’s website, facebook, instagram, printouts, etc. If you want to be exempt from this then you will need to let us know specifically.

No matter how careful we are, as with any sporting activity, there is a risk of injury. Please select accept below to agree not to hold NZ Wushu Academy or any of its staff / members / coaches / volunteers responsible for any injury a student may sustain during their participation.

I accept