Tactical Close-Quarters Combat and Self-Defense (T.C.C.S.D) Survey

1.Please answer the following.(Required.)

First and Last Name:

Phone Number:

Email:

Sex:

Age:

2.What is your qualifying organization (CPD, CFD, EMS) and Location/unit?(Required.)

3.What is your height in feet and inches? For example, if you are 5 feet and 4 inches, write 5’4”.(Required.)

4.What is your current weight in pounds?(Required.)

5.When was the last time you received martial arts training?(Required.)

Never

Within the last year

Between 1 - 3 years

More than 3 years

If you have/are training, what discipline/disciplines, and what was/is your length of training?

6.Assuming you enjoy the training, please select one of the following:(Required.)

I am ready to commit to a minimum of 4 weeks of training.

I am interested but unable to commit to this session, please keep me in mind for the next session

I am interested but not certain when I can commit.

7.Do you have family that would be interested in learning hand-to-hand combat, martial arts, and self-defense?

Yes

You will be notified via Text message if you are accepted to the class.

Based on the interest and value found in the classes, I plan on molding this course for the specific needs and uses of the CPD. If there is consistency in training, I am 100% positive that this will one day save lives. From the bottom of my heart, I thank you for the opportunity to share any bit of knowledge I have to help keep you, your families, and our communities safer.

Current Progress,

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Tactical Close-Quarters Combat and Self-Defense (T.C.C.S.D)

New Student Questionnaire