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Introductory Lesson Registry

1st Child's Name

I would like my child to improve

Confidence	Assertiveness	Fitness	Discipline	Focus
Self-Control	Safety	Awareness	Self-Defense

2nd Child's Name

I would like my child to improve:

Confidence	Assertiveness	Fitness	Discipline	Focus
Self-Control	Safety	Awareness	Self-Defense

Mom's Name

Dad's Name

Address

Phone Number

Email:

I would Like to attend:

Introductory Lessons are available at 5:00 or 6:00 Mon. thru Fri. and 10:00 or 11:00 on Sat.

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For more information:
ATA Martial Arts
Red Oaks Mill Plaza
43 Vassar Rd
Poughkeepsie, NY 12603 US
Email: tkdgerdunn.ny@netzero.net
(845)462-0624

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