Try a Class

In order to sign up for you or your child's free trial class, please enter the correct information in the form below. A MAX Impact representative will contact you to confirm the date and time for the trial class.

Age
Program of Interest	Total Defense Brazilian Jiu Jitsu Panthers Select Program
First Name
Last Name
Sex	Male Female
Parent / Guardians First Name
Parent / Guardians Last Name
Home Phone
Alternate Phone
Emergency Phone
Email Address
How did you hear about us	Internet Referral Brochure Other How did you hear abour us?
Are you interested in adult classes?	Yes No
Desired Day of the Week for a Trial	Monday Tuesday Wednesday Thursday Friday Saturday
Desired Time of Day	Morning Early Afternoon Late Afternoon Night
Additional Comments?

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