NEW Welcome Pack

Kicksmart Tae Kwon-Do

Instructors: Tim Hill and Anja Hill www.kicksmart.co.uk
Email: instructor@kicksmart.co.uk
Phone: 07340 036 768

Office Address: 39 Mona Avenue, Kingsway,

Quedgeley, Glos, GL2 2ET
WELCOME to the KickSmart Tae Kwon-Do enrolment process.

Please fill in this form and ensure all answers are given truthfully and to the best of your knowledge at the time of completing.
Please enter your height below in centimetres so that we may order your club dobok (suit)
Please Enter Your Height in CM*
Enrolment Your first month is considered your enrolment month

Enrolment Fee = £78.00

Please fill in your payment details at the bottom of this form.

Your enrolment fee includes your First month’s unlimited training, Yearly licence (renewal required anually), Training Handbook, TAGB Training suit.

All of these items are greatly discounted, to assist you, when starting your training with the TAGB.
Monthly Membership Options

Full member (Unlimited training) £36.00 per month

(ONLY paid by standing order- please use details below to set up with your bank)

Half member (Once week training) £28.00 per month

(ONLY paid by standing order- please use details below to set up with your bank)

Family Membership Each additional family member can discounted by £5.00 per calendar month

(ONLY paid by standing order- please use details below to set up with your bank)
******* Please Note *******

It is the students/parents responsibility to ensure that all monthly fees are paid by the 1st of every month after your enrolment period.

ALL FEES ARE PAYABLE BY STANDING ORDER WHICH MUST BE SET UP USING YOUR ONLINE BANKING OR BY CONTACTING YOUR BANK.

Please use the follwing benificary details:

ACCOUNT NAME: KICKSMART TAE KWON DO

BANK: VIRGIN MONEY

ACCOUNT No. 70536371

SORT CODE: 82-11-07

Membership is continuous. If you wish this to be terminated, please notify your instructor before cancelling your standing order so they can make your place available to a new student. Your yearly T.A.G.B. & B.T.C. licence is discounted in your enrolment fee,

Only equipment obtained through the T.A.G.B. may be used within your Tae Kwon-Do School. All equipment and training aids MUST be obtained through your T.A.G.B. School Instructor.
BRITISH TAE KWON-DO COUNCIL LICENCE PERSONAL ACCIDENT INSURANCE
Whilst injuries in Tae Kwon-Do are not quite common place as in other contact sports these can at times, be so serious as to dramatically affect the injured party or even result in death. The natural reaction in such cases is to seek compensation and this will involve court action which may or may not be successful. It is estimated that only one in five such actions results in an award of damages and a seven or eight year delay must be anticipated. Personal accident insurance will provide such automatic compensation without the need to prove that anybody is liable.

To provide immediate compensation without need to prove liability or pursue court action The British Tae Kwon-Do Council have arranged Personal Accident Insurance in respect of all members. This should ensure that in the event of death a sum is available to the member’s direct dependents but where permanent total disablement, such as loss of an eye, a limb, or total inability to pursue an occupation occurs, higher compensation to help rebuild a shattered life is called for. Whilst no amount of compensation can adequately replace the quality of living previously enjoyed, a sensible benefit of around £25,000 is considered suitable.

Weekly benefits to assist, but not to replace for the loss of wages is also insured through this particular benefit only applies to people in waged employment. The British Tae Kwon-Do Council considers this fact relative to the ages and employment conditions of their membership and to this end a small degree of assistance is given to students and junior members.

The benefits are as follows;

Death                      £5,000 per Insured Person of under 18 years of age

                                £25,000 per Insured Person over 18 years of age

Total and Irrecoverable loss of sight in one or both eyes £25,000

Loss of one or two limbs £25,000

Total and Irrecoverable loss of sight of one eye and Loss of one limb £25,000

Permanent Total Disablement

Total loss of sight of one or both eyes or loss of limb £25,000

Temporary Total Disablement £5 per week per Insured Person of under 16 years of age. Entitlement of this benefit is to a maximum sum of £250

£60 per week per Insured Person over 16 years of age in full / part time employment.

Entitlement to this benefit is dependent upon loss of earnings incurred to a maximum of £60 per week.

Maximum sum payable £3,000

£15 per week per Insured Person who is unemployed and students in full time education. Entitlement to this benefit is dependent upon loss of any other benefit / grants due to the injury to a maximum of £15 per week. Maximum sum payable £300

To qualify for any of these benefits you must have been absent from employment or studies for a period of more than two weeks and proof of absence and loss of earnings will need to be supported by official paperwork i.e. Medical Certificates

In order for any of the above benefits to be applied, claims should be submitted on an official claims form to the Insurance Officer of the British Tae Kwon-Do Council within 21 days, failure to do so will jeopardise your claim and may result in loss of benefits.

Liability Insurance

Injury to a third party or damage to property of others could almost automatically result in a claim for damages, such claims and their associated expenses should the case go to court can be very costly. In the absence of adequate Liability Insurance, members will find themselves financially responsible for any damages and costs awarded, to his end included in the membership insurance of the British Tae Kwon-Do Council is a Third Party Liability Insurance for all its members.

Benefit is as follows; Limit of Liability        £5,000,000 / unlimited in any one of insurance

Members Professional Indemnity

As a Tae Kwon-Do student regardless of grade at some time you may be requested to assist the Instructor and train junior grades within the lesson. To this end in order that you can do this officially the British Tae Kwon-Do Council has included in its membership insurance Indemnity cover to the sum of £1,000,000.

All insurance cover is only available to British Nationals and student who have resided in the U.K. for longer than six months.

By signing this form I am confirming that I have read the above information, understand and agree to the conditions laid out.

Please note: membership will not be accepted unless this form is signed and returned and confirmed as being read on the licence application form.
Students Name:*
Signed:*

Clear
Date:*

DayMonthYear
Date
TAGB MEMBERSHIP APPLICATION FORM
NEW APPLICATION*

NEW APPLICATIONRENEWALRE STARTINGLOST DETAILS
NEW T.A.G.B. SCHOOL*
PREVIOUS TKD SCHOOL
PREVIOUS ID No
LICENCE No
EXPIRY DATE

DayMonthYear
Date
GRADE
Age Group*

SeniorJunior (Under the age of 16)
Gender*

MaleFemale
DO YOU SUFFER FROM ANY OF THE FOLLOWING? Tick if Yes*

HEART DISORDERASTHMAMIGRAINEEPILEPSYDIABETESNERVOUS DISORDERHAEMOPHILIAHAY FEVERNONE OF THE ABOVEOther
HAVE YOU ANY PHYSICAL INJURIES OR DISABILITIES?*

YESNOOther
DATE COMMENCED TRAINING*

DayMonthYear
Date
DATE OF LAST GRADING

DayMonthYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
TEL No*
Email*
example@example.com
OCCUPATION*
DATE OF BIRTH*

DayMonthYear
Date
HAVE YOU BEEN SHOWN YOUR INSURANCE DETAILS? (Page Above)*

YESNO
HAVE YOU BEEN SHOWN OUR PRIVACY POLICY (paragraph below)*

YESNO
APPLICANT'S SIGNATURE (Parents' if under 18 years)*

Clear
DATE*

DayMonthYear
Date
Physical Activity Readiness Questionnaire (PAR-Q) and You

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming physically active. The questions below will indicate if you should check with our doctor before you start. If you are over 69 years of age and you are not used to being very active, you should check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: tick YES or NO.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*

YESNO
Do you feel pain in your chest when you do physical activity*

YESNO
In the past month, have you had chest pain when you were not doing physical activity?*

YESNO
Do you lose your balance because of dizziness or do you ever lose consciousness?*

YESNO
Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*

YESNO
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*

YESNO
Do you know of any other reason why you should not do physical activity?*

YESNO
Students Name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DATE OF BIRTH*

DayMonthYear
Date
CONTACT TELEPHONE NUMBER (Daytime)*
CONTACT TELEPHONE NUMBER (Evening)*
Signature*

Clear
Signature of parent or guardian if participant is under the age of 18

Clear
Date*

DayMonthYear
Date
Further Medical Information and Emergency Contact Details
Students Name:*
Please detail below any important medical information that our instructors should be aware of. (e.g. Autism, ADHD, Asthma, Epilepsy, Diabetes, etc)
Other important information we should know?
EMERGENCY CONTACT DETAILS

To be completed by parent/guardian if student under the age of 16

Please insert the information below to indicate the person(s) who should be contacted in case of an incident/accident:
Home Contact Telephone Number*
First Contact Name/Relationship*
First Contact Number*
Second Contact Name/Relationship
Second Contact Number
Contact Email Address*
example@example.com
Photography

From time to time we take photographs during our T.A.G.B. Tae Kwon-Do activities. We would like your permission to use these photographs in our marketing. We will never reference your child by name or provide any specific information regarding your child. We will use them exclusively for TAGB Tae Kwon-Do marketing.
Please tick the appropriate box below.*

YES. I give you permission to use photographs of my child on in your TAGB Tae Kwon-Do marketing.NO. Please do NOT take or use any photographs of my child.
Students Name (PLEASE PRINT):*
Parent/Guardian Name (PLEASE PRINT)
Student/Parent or Guardian Name (Signature):*

Clear
Student Enrolement Fee

Enrolment Fee Payment*

Student Enrolment Fee£78.00

One off enrolment fee that includes your first months training fee, training suit and annual license fee. Please ensure you have set up your standing order to be paid on the 1st of every month following your enrolment period, as detailed at the beginning of this form.

Total £0.00

Payment Methods

Credit Card

Apple Pay

Should be Empty:

BRITISH TAE KWON-DO COUNCIL LICENCE PERSONAL ACCIDENT INSURANCE

TAGB MEMBERSHIP APPLICATION FORM

Further Medical Information and Emergency Contact Details

Student Enrolement Fee

Payment Methods