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Thatcham Karate Club enrolment form ( 2007 )
(Mandatory information in grey. Please print information)
Name |
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Address |
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Home Tel Number |
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Mobile |
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DOB ( If under 18) |
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Email |
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SKW licence No.(blue book) |
(see note below) |
Expiry date |
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Emergency contact |
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Emergency Tel No. |
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Note : It is essential that all students ensure that their SKW / EKGB licence is up to date. Failure to do this could result in accident insurance cover being invalid. New students are advised to apply for a licence as soon as possible and to supply details to the instructor when received.
Relevant Medical Information or Special Training Needs
Karate training is a physically demanding activity. If you currently have any health conditions likely to affect your fitness to train please contact your GP before commencing training (e.g. current or past problems with heart, respiration, circulation, limbs, joints, severe head injury, diabetes, blackouts, etc.).
If in the future your health changes so that it could affect your fitness to train, please contact your GP for advice before continuing with your training. If your GP makes any recommendations that the Karate Instructor should be aware of, please make these known in the space below (in some cases a letter from your GP may be required). If you have any other special training needs that you feel the instructor should be aware of, please also give details
Please note that any information supplied will be made available to visiting Instructors to ensure that your requirements are met.
Note to Parents
If you leave your child at the Dojo (training hall) please ensure he/she is dropped off and collected from within the hall (not outside) while the instructor is present. The club cannot be held responsible for children outside the Dojo before or after training. Upto date emergency contact information is essential for children who are to be left at the club.
Declaration
I accept the above conditions and understand that Karate training is a physical contact activity involving risk of personal injury and I will not hold the club or any of its instructors or members responsible for any injury I may sustain. I also understand that Karate should only be used in self defence and the Karateka should never attack first.
Signed : ________________________________ (If under 18, signature of Parent / Guardian)
Date : ____ / _____ / 2007
Please return completed form to the club instructor
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