Honor, Integrity, Service UMA
(904) 803-2572
United Martial Arts Jacksonville, FL.
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Medical Information - All medical information will be kept confidential
It is very important that we are aware of any medical conditions you or your child may have, especially any that may affect you or your child's training.
*
Indicates required field
Have you consulted a physician prior to entering this program?
*
Yes
No
Do they have any of the following?
*
Asthma/Bronchitis
Previous Broken Bones
Heart Conditions/Arrhythmia
Free Bladder
Back/Neck Problems
Diabetes
Allergies
Does the student applying have any medical conditions that may affect their training?
*
Yes
No
Please check any that apply.
*
ADD
ADHD
OCD
ODD
Autism or any other Autism Spectrum Disorder
Comments and special instructions
*
Please give necessary information concering any item(s) circled above
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