Beloit Janesville Area Taijutsu Study group Application

We ask that you fill out this simple application and questionnaire, so that we have a better understanding of you and have any pertinent information in case of emergency, contact, or for any other reason concerning B.J.A.T.  All information will be kept confidential.

 

Name:___________________________________________________

 

Nicknames/Aliases:_________________________________________

 

Address:__________________________________________________

 

City:____________________________________ State:_____________

 

Zip:_________________ 

 

Phone Number you can be reached at: ___________________________

 

Emergency Contact and number  _______________________________

 

Email:______________________________________

 

 

Any Training in Taijutsu ____________________

 

If yes where when and what Kyu level do you have:__________________________________________________________________

 

If needed do you have proof of Kyu Level:___________________________________

 

Any training in another martial art:____________________________________

 

If  yes state which one(s) and when.__________________________________