Membership Form

First Name

Date of Birth

Post Code

Mobile No.

Account Password

Date of Starting

Surname

Address

Telephone No.

Confirm Password

Photo

Does the applicant suffer from Astama. Yes No

Please mention any disabilities.

Please mention any other martial arts studied and any grades obtained.

Does the applicant wear Glasses/Lenses. Yes No

Please mention anything else that you think may help the instructor during coaching. (i.e. shy,lacks confidence etc.)

Select Dojo:

V - Heston Village Hall TW5 OLW

Classes:

K - Heston Village Hall TW5 0LW

Classes:

H - Berkerley Primary School TW5 9HQ

Classes:

M - Mortem Sports Center SL1 2QG

Classes:

S - Southhall Lancaster Rd. (St. George community center) AB1 1NP

Classes:

Enrollment Fee (Paid only once): £12.00

Dvd Volume.1 (Optional for beginners)

Term End

Current Quarterly Term Fee: £ 0.00

Annual Membership & Insurance: £18.00

Karate Suit (Complete Kit)

Total: £ 0.00

I understand the details provided will be held in a database (PC) for record purpose only.
I give permission for administration of any first-aid if .
I understand that instructor is only responsible for my child whilst within the boundaries of the training hall and i am responsible to ensure that an instructor is present before leaving the child for each leason.

Training fees are paid in advance per quarterly term (unless otherwise instructed)
All students must attend classes regularly, in a clean Karate Suit with the necessary protective pads as instructed by instructor.
All items of Jewellery, rings, watches etc. must be removed prior to practice.
Lengths of absense must be reported to instructor (i.e. holiday, hospitalisation, long term sickness, exams etc.)

Training fees are to be paid regularly in advance as indicated by the area instructor.

Term Fee Due: £ 0.00

Term Fee Due Date: 22 January 2025