WAH
LUM KUNG FU TEMPLE
Headquarters of the United States Traditional Chinese Martial
Arts Team
851 N. Goldenrod Road, Orlando,
FL 32807 407/275-6177
Training Program Application
NAME_____________________________
DATE OF BIRTH____________ SS#____________________________
ADDRESS___________________________________________ HOME PHONE____________________________
CITY_________________________ STATE__________ ZIP_______________ Program______________________
BUSINESS ADDRESS__________________________________________________________________________
OCCUPATION___________________________________________ BUS. PHONE__________________________
E-MAIL ADDRESS _____________________________________________________________________________
1. Do you have any physical handicaps? 3. If taking Medication what is it for?
No_____Yes_____What Kind___________ _________________________________________________
2. Do you take any medication? 4. How many consecutive years in Martial Arts
& what style?
No_____Yes_____What Kind____________ _________________________________________________
5. Do you have any intention of teaching martial arts or do you currently teach?
a. Intend to teach Yes_____No____ b. Teaching now Yes_____No_____
6. State reasons for learning Kung Fu______________________________________________________________
7. Please state date of arrival and departure _________________________________________________________
If pick up needed from airport, please state flight #, time and arrival information ($25 rt) ______________________
(no pick up available after 7pm - 8am)
"In consideration of my attendance and participation in the Kung Fu Classes,
hereby, for myself, my heirs,
executors, administrators and assigns, hereinafter referred to as student, do
hereby, remise, release and
forever discharge Chief Instructor, Master P. Chan, his assistants, the Wah
Lum Kung Fu Temple, its officials,
its agents, principals, successors and assigns and other persons, firms, or
corporate bodies, participating in or
connected with Master Chan, of and from all manners of actions, causes of action,
claims or demand or may
hereafter have, for or by any reason of participation in the Kung Fu classes,
a loss, damage or injury sustained
by the Student, or in respect of loss of any equipment used by the Student during
the Kung Fu classes or
participation in any exhibition, demonstration, performance on behalf of the
Wah Lum Kung Fu Temple.
I understand and agree not to show or teach any material including, exercises,
forms, techniques, weaponry,
herbal application or any other material that is taught to me at the Wah Lum
Temple without written permission
and proper certification.
I also understand and agree that I cannot solicit or use the name of Wah Lum
in any way for whatever reason without permission.I
have read the rules and regulations of the Wah Lum Kung Fu Temple and agree
to pay $_______registration fee which I understand is non-refundable plus a
$100 Deposit, which I understand is refundable after dorm inspection.
I also agree to pay $______ for Program____ which I understand is non-refundable.
On default of any payment due to Wah Lum Kung Fu Temple, I agree to pay reasonable
attorney fees and/or
court costs and collection fees. Interest rate of 18% annually or 1.5% per month
assessed on any unpaid
balance. I testify that all the above information filled out is true.
DATE_______________ SIGNATURE_____________________________________________
