Martial Arts School Transfer

Changing Lives Martial Arts Transfer Request

Required Data to be completed by “Transferring Academy” (TA)

Transferring Accademy (TA):
Academy Phone
Transferring Academy School#
Transfering Academy FAX #:
Email
School Owner:
Transfer Academy has sent a transfer package and/or made a courtesy call/email to one of our local Changing Lives ATA Martial Arts Academies prior to transferring the student:
- Yes
- No
Transfer Academy membership agreement must be attached to this “Request To Transfer Form”.
Name
First Last
Birthdate
Phone
Address
Street Address City State ZIP Code
Students permitted to train on membership agreement:
Students Name:
Student ID #:
Students Name:
Student ID #:
Students Name:
Student ID #:
Students Name:
Student ID #:
Billing Company Name:
Buyers Billing Account #:
Current Monthly Payment: $
Down payment made: $
Paid in full amount: $
Last Payment Date:
Amount Paid: $
(TA)Membership Start Date:
(TA) Membership end date:
When was the last membership paid:
Program type:
Current Rank:
Last testing date:
Has student earned his/her collar stripe:
- Yes
- No
Current Collar Level:
Current Association Membership Expiration Date:
Is this the first time you have transferred a student to one of our local acadamies?
- Yes
- No
For any membership that has been paid in full for a period of 6 months or longer there may be a $299.00 transfer processing fee that will be paid by the transferring school. The school (TA) may select the student to pay the fee or pay the fee out of the paid in full account that was collected. The Transfer Fee and appropriate paperwork is to be turned in prior to the start of training.

Changing Lives Martial Arts Transfer Request

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CLMA - Princess Anne

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CLMA - Greenbrier

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