Affiliate Request Form

If you are interested in becoming an affiliate Academy/Gym with Genkai Impact, please fill out the form below and a representative of our team will get in touch with you.

Becoming an affiliate means that when Beneficiaries come through our Genkai Impact Program, your school will be a safe place where new potential students can be enrolled.

Affiliates agree to take on the responsibilities of being an encouraging and educational space for Beneficiaries that become enrolled in their programs.

Name

First Name

Last Name

Age

Phone

(###)

###

####

Academy/Gym

Website

http://

Social Media Handles (If Any)

Where is your Academy/Gym located?

What is the cost of tuition?

Do you own the Academy/Gym?

Are you a Professor or Coach?

Belt Rank

Does your school have a Kids Program?

How many students do you have?

How long has your Academy been open?

Is there a required school uniform?

What does a weekly schedule look like for your school?

What is the minimum age and belt rank for a student to enter the adult program?

Do you have other instructors at your school?

Do you have Background Checks done for your staff and instructors?

How do you feel about your community?

Are you okay with us sharing information about your gym on social media?

For example: Sharing that you are an Affiliate School with us at Genkai.

Tell us more information about yourself and your school that you feel that we should know:

This allows us to get to know you and your community better.

Affiliate Request Form

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