top of page
PARK'S MARTIAL ARTS
SCHOOL OF SELF DEFENSE
New Location in Eastsound | 541.580.9862
Home
Programs
Instructor
Gallery
Student Resources
Uniform & Equipment
Waiver
Training Calendar
Contact
More
Use tab to navigate through the menu items.
Registration Form
*
Student's First name
*
Student's Last name
*
Email
*
Date of Birth
*
Phone Number
*
Street Address
*
City
*
State
*
Country
*
Postal Code
*
Emergency Contact
*
Phone Number
Choose Desired Program:
Kids Program
Youth Program
Teens & Adult Program
Women's Self Defense
*
What got you interested in joining our program?
*
How did you here about us?
*
Are there any medical conditions that we should be aware of?
List any previous martial arts and/or self defense experience.
For Tuition Evaluation, please check all that apply to you.
Active Duty Military
Military Veteran
First Responder
Nurse
Teacher or Faculty Member
Receive OHP / SNAP / WIC Benefits
SUBMIT
Park's Martial Arts Registration
Wednesday Nights
662 SE Jackson St., Roseburg, OR 97470
bottom of page
