Student's Name

First Name

Last Name

Student's Birthday

MM

DD

YYYY

Students Group Age

Email

Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact/ Guardian's Name

First Name

Last Name

Emergency Contact/ Guardian's Phone

(###)

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Teens Capoeira Jackson Springs

Starter Package ($315)

3 months Starter Package bundle including:
Tuesday & Thursday
6:00 pm -7:00 pm
+ Free Uniform shirt
+ FREE Uniform Pants
**NEW Members Only
Teens Capoeira ($105)

Monthly 2x week Capoeira
Tuesday & Thursday
6:00 pm -7:00 pm
Monthly 1x week ($90)

Monthly 1x week Capoeira
Tuesday OR Thursday
6:00 pm -7:00 pm
10x Classes Punch Card ($275)

10x Kids Capoeira Classes pass
Tuesday & Thursday
6:00 pm -7:00 pm
**Valid for 3 Months

Capoeira information 2025 2 2

Student's Name

First Name

Last Name

Student's Birthday

MM

DD

YYYY

Students Group Age

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact/ Guardian's Name

First Name

Last Name

Emergency Contact/ Guardian's Phone

(###)

###

####

Text

Starter Package ($315)

Teens Capoeira ($105)

Monthly 1x week ($90)

10x Classes Punch Card ($275)