New Customer Registration Form

WELCOME TO THE TOSHIKAI DOJO

Please fill in the form below
Student's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal Code
Date of Birth *

Month Day Year
Phone Number *
E-mail *
Emergency Contact *

First Name Last Name
Phone Number *
Class Session *

September-January ($275) January-June ($275) Zoom Online September-January ($180) Private Lessons (time to be arranged with Sensei Susan)
Class Time *

Wednesdays 4:30-5:15pm (all ages) Wednesdays 5:30-6:15pm (all ages) Sundays 10:00-10:45am (youth) Sundays 11:00-11:45am (teen/adult) Tuesdays on Zoom 6:00-6:30pm (all ages)
Uniform ($45)

Yes No
Price
CAD
Method of Payment

E-Transfer (susan@senseisusan.com) Cash or Cheque (Payable to S. Baldassi)
Are there any health concerns that you feel we should know about?
How did you hear about our program?

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