Student Registration Form

Thank you for joining Phillips Martial Arts and Yoga Center. Please complete the New Student 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.

CURRENT SUMMER SPECIALS: Prepay 2 months and 3rd month is FREE!

Student Name:

Parent Information: (if enrolling minor)

Tuition Payment (Auto Pay)

Credit Card Information

Payments automatically withdrawn on the first of every month by credit / debit card.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.

Note: In Studio/Cash or Check Payment

“Direct Payment enrollment Option (tuition paid by cash or check each month):  Enrollment must be completed on site. There is a $50 initiation fee, and  first and last month tuition due at enrollment.”

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.

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