Trial Class Intake

GRACIE COOS COUNTY · COOS BAY & COQUILLE

Five quick steps help a coach match the right academy, class, and starting level for you.

No payment is due. Your request becomes a reservation after a coach confirms the class with you.

STEP 1 OF 5

Who is training?

Start with the student who will be attending the trial class.

Who is the trial class for? *Adult — age 18 or olderTeen — age 13–17Child — age 4–12

Student’s Full Name *

Student’s Age *Enter the student’s current age.0 / 3

Parent or Guardian’s Full Name *

Relationship to Student *

STEP 2 OF 5

Goals and Experience

No experience is required. Honest answers help us recommend a comfortable first class.

What is your martial arts experience?None — this is my first timeI have tried a few classesLess than one yearOne year or more

What matters most right now? *Practical self-defenseFitness and stress reliefConfidence, focus, or resilienceCommunity and learning a new skillCompetition and performanceStriking or MMA development

What would make your first class feel successful?Optional: Tell us about any questions, concerns, or goals you want the coach to understand.

STEP 3 OF 5

Academy and Availability

Select what fits your life. A coach will compare your answers with the current schedule.

Which academy works best? *Coos Bay — 454 Commercial AveCoquille AcademyEither academy — help me choose

What time range usually works best?Youth class time — around 5:00 PMEarly evening — 5:30–7:00 PMLater evening — after 7:00 PMSaturday morningFlexible — recommend the best class

When would you like to start?As soon as possibleWithin the next two weeksLater this monthI am exploring options first

STEP 4 OF 5

Contact and Readiness

Tell us how to confirm the class and anything relevant to a safe, comfortable first visit.

Best Contact Email *

Best Contact Phone

Preferred Contact Method *EmailPhone callText message

Is there anything a coach should know before class? *This may include an injury, mobility consideration, health concern, sensory need, or accommodation request relevant to safe participation.NoYes — I will explain below

Information for the Coach *Share only what is relevant to planning the trial class. Do not use this form for an emergency.

How did you hear about Gracie Coos County?

Referring Member’s Name *

STEP 5 OF 5

Waiver and Request

What happens next: A coach will review the student’s age, goals, experience, academy preference, and availability, then contact you with the best starting option.

This form requests a trial class; it does not confirm a reservation. Every participant must complete the digital waiver or sign the paper waiver at the academy before participating.

How would you like to complete the required participation waiver? *Choose one. The waiver must be completed before the student participates in class.Complete the digital waiver online after submitting this requestSign the paper waiver at the academy before participating

Digital waiver: After submitting this request, you will be taken to the academy’s permanent waiver page. Complete and submit that waiver before class.

Paper waiver: Please arrive 10–15 minutes early. The student cannot participate until the paper waiver is completed at the academy.

Your first classstarts here

We’ll help you walk in ready

You do not have tofigure it out alone