Student Registration Form

Name *

First

Last

Date of Birth *

Email *

Your email will be used to contact you with information regarding the club and for access to the training app.

Main Contact Number *

Alternative Contact Number

Address *

Emergency Contact Details *

Please provide name, relationship and contact number for at least one emergency contact

Medical Conditions *

Do you have any medical conditions we should know about? Recurrent injuries? Disability? Learning difficulty?

If you answered yes to 'Medical Conditions' please give details

Why do you want to learn Karate? What do you hope Karate will do for you? *

Any previous martial arts experience? If so, please give details of style and grade achieved *

By completing this form I state that the above information is true and correct. I undertake to abide by the terms and conditions of Milton Keynes Shotokan Karate Club, as explained by its instructors. *

I agree

I accept that, whilst all reasonable care is taken, my instructors are not legally responsible for any accidents or injuries which may occur whilst I am training at their class. I also understand that I am expected to maintain a standard of behaviour, both during training and in general, which will not bring Milton Keynes Shotokan Karate Club into disrepute, knowing that failure to do so may result in expulsion. *

I agree

I am medically fit to undertake intensive physical training. *

I agree

DECLARATION: I promise to uphold the true spirit of Milton Keynes Shotokan Karate Club and martial arts in general. I promise never to use the skills that I am taught against any person, except for the defence of myself, my family or friends in the instance of extreme danger or unprovoked attack, or in the support of law and order. *

I agree

Name of Parent / Guardian if under 18 years of age

First

Last

86958