Klein's Black Belt Academy, All Rights Reserved.
Signing up for classes is now even easier.  Just submit the below registration.  If you have any questions, please
call (262) 758-3378.  If we're not available please leave a message and someone will return your call as soon as
possible.  You can also email us at  contact@blackbeltacademyinfo.com
Register Now
Klein's Black Belt Academy • Burlington, Wisconsin • (262) 758-3378
e-mail Mr. Klein • http://www.blackbeltacademyinfo.com/
A member of the American Taekwondo Association
NEW STUDENT REGISTRATION
Please note that registration does not automatically guaranty enrollment.  Minimum student class sizes are required.  
Classes fill up on a first come first serve basis.  Spots are only held once payment is received.  Fill out a separate
registration for each student.
Student Information:
Name (First and Last):
Birthday (MM/DD/YYYY):
Class interested in:
New Student Special
Tiny Tigers         (Ages 4-6)             Mon 5:50pm, Wed 5:50pm, and/or Sat 8:50am
Karate for Kids (Ages 7-14)          Mon 6:25pm, Wed 6:25pm, and/or Sat 9:25am
Adult/Teen         (Ages 15+)            Saturdays 11:00am
A waiting list currently exist for the adult/teen class.  A minimum number of students
are needed to hold class.
Not sure
Date you plan to stop by:
Please check the Calendar area to
make sure there are no special events
on the day you plan to stop.
If student is under 18 years old:
Your Name:
Relationship
to Student:
Contact Information:
Address:
City:
State
 Zip:
Email address:
Phone number:
What aspects of martial arts are you interested in?
Self-confidence
 Confidence
 Family Activity
Self-defense
 Concentration
 Fitness
Coordination
 Discipline
 Stress Relief
Other (please list):
How did you hear about us:
Friend/Family
 School Flyer
 Sign/Banner
Poster
 Web site
Other (please list):
Additional Comments/Questions: