gEEast/West Combat Arts

2007 – 2008 Registration Form

Instructor: Phillip R. Garrison, 2nd Degree Black Belt

For more information, please call 704-678-4164 or you can e-mail Phillip at samuraiaenima@hotmail.com

Classes Currently Offered:

Ø     Adult MMA (Ages 14+) -  A reality-based martial arts system which utilizes Muay-Thai kickboxing and western boxing for striking, Brazilian Jiu-Jitsu for takedowns and ground-grappling and submissions, plus Small-Circle Jiu-Jitsu for stand-up grappling, submissions and controls.  Pistol and knife disarms from jiujitsu and Krav Maga. Also introduces Filipino stick/knife training.  Emphasizes real life situations and high-intensity training sessions and drills which are designed to lessen the reaction time required to successfully counter attacks.

Ø     Junior MMA (Ages 8-13) - A reality-based martial arts system which utilizes Muay-Thai kickboxing and western boxing for striking, Brazilian Jiu-Jitsu for takedowns and ground-grappling and submissions, plus Small-Circle Jiu-Jitsu for stand-up grappling, submissions and controls.  Pistol and knife disarms from jiujitsu and Krav Maga. Also introduces Filipino stick/knife training.  Emphasizes real life situations and high-intensity training sessions and drills which are designed to lessen the reaction time required to successfully counter attacks. (Much like the adult class but geared toward younger students)

Ø     Little Samurai (Ages 3-7) – A fun, laid-back introduction to martial arts for young children. Emphasizes games, drills, getting along with others and exercise.

Ø    Jedi Academy (Ages 5-15) – This class teaches kenjutsu (samurai sword arts) in a Star Wars format.  With enrollment in this class the student will receive a jedi robe and wooden bokken (sword).  When the student progresses to rank of Jedi Padawan, he/she will be allowed to use a dueling lightsaber in class.

*Please download, complete and bring with you to your first class

Student’s Name:  __________________________

E-Mail Address:  __________________________

Home Phone:  ___________  Work:  ____________  Cell:  ___________

Address:  _________________________________________

City:  ____________________   State:  ____________  Zip:  _______

Date of birth and school year:  __________________________

Parent/Guardian:  __________________________

Years of martial arts experience:  _____

Emergency Contact:  ___________________________

Classes Desired               Class                     Day                       Time

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·        ___________________________________________

·        ___________________________________________

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Although every effort is made to create a safe environment, I realize there is always risk of accident.  If necessary, I authorize Phillip Garrison to administer first aid treatment and/or emergency treatment for my child on my behalf.  I further release Phillip Garrison from liabilities for injury or damages arising out of personal injury of any kind.

Parent/Guardian Signature:  ___________________________________