Student Application

Complete the application below. Your application will be reviewed by an instructor.

This application is for

Applicant Name

Last

First

Middle Initial

Chinese Name

Date of Birth

Sex

Contact Information

Home Address

City

Zip

Home Phone

Work Phone

Other Phone

Current Occupation

City of Occupation

Background Check

Have you ever been arrested?

If yes, please explain

Driver License ID No.

Emergency & Health

Emergency Contact Name

Relationship

Emergency Phone

Health Care Provider

Do you have any medical conditions?

If yes, please explain

Interests & Experience

How did you hear of Yau Kung Moon?

What do you hope to learn?

Kung Fu Lion Dancing Other

Any martial arts experience?

Any lion dancing experience?

Account Login

This email and password are used to sign in to the member portal.

E-mail Address

Password

At least 8 characters.

I acknowledge that the instructors, students and other guests are not liable for any injuries I may receive at the school, martial arts/lion dancing demonstrations and community performances/services. The above responses are true to the best of my knowledge. I have read and agree to follow the YKM Rules.

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