Pre-K Registration Form

Thank you for joining Phillips Martial Arts and Yoga Center. Please complete the Pre-K Registration Form below.

All information is kept strictly confidential. Only fully completed forms with payment will be accepted. An email confirming your enrollment will be sent to you shortly.

Pre-K *

Please choose your fitness program: *

Student Name:

Last: *

First: *

Credit Card Information

Card Number *

Full Name On Card *

Card Expiration Date (mth/yr) *

Billing Address, City, State, Zipcode *

Security Code (on back of card) *

Payments automatically withdrawn on the first of every month by credit / debit card. INITIATION FEE WAIVED WITH AUTO PAY. If pro-ration applicable, pro-ration will appear on the next billing cycle. $20 No payment fee applied to account if Auto Pay payment does not process or is declined.

I give Phillips Martial Arts and Yoga Center (Robert Phillips, Phillips School of Kung Fu San Soo) permission to debit / charge the account provided within seven days from this online registration, and agree that the charge will reoccur on the first day of every month, and continue every month.

I want to enroll in automatic billing. *

Initials: *

Cancellation Policy

I agree that in order to stop the monthly charges applied to my account, that I will fill out a stop payment form provided by Phillips Martial Arts and Yoga Center, (obtained at studio location) 10 days prior to the end of the month.

Initials *

Privacy and Consent: *

I have read the Client Privacy & Consent form before submitting this form. Submitting this client registration form indicates that I have read and agree to the terms and conditions of privacy and other conditions set forth.

NOTE: If prefer you to pay for tuition by direct pay then please contact us directly via email by clicking on the button below.

Email Us

2 + 0 = ? Please prove that you are human by solving the equation *

Privacy Notice