Adult-Teen Intake Form At Spirit of the Heart we are committed to helping each student reach their individual training goals. Please fill out this form completely, so we can get to know you better in order to serve you to the best of our ability. Date Student's Full Name Student's Email* Address* Student's Age* Birthdate* Parent's Full Name (if Student is Under 18) Parent Email Address (if Student is Under 18) Emergency Contact Name* Emergency Contact Phone* How Did You Heart About Us?* Friend Family Member Google Bing Yahoo Facebook Instagram Drive By I Am a Returning Student What Benefits Would You Like to Receive From Your Training? Physical Fitness and Conditioning Focus Increased Awareness Healing From Past Trauma (Use Space Below to Share More) Combat Depression Combat Anxiety Self-Acceptance Confidence Anger Management Self-Defense Inner Calm Try a Rewarding Group Activity Reaching Goals Want to do Our Specific Martial Art Other Tell Us More... Share Any Physical Health / Injury Concerns. If You are Working, What is Your Current Occupation If Student is in High School, Which School Do They Attend? Homeschooling? What Are Your Other Interests and Hobbies? Submit
