New Student Registration Form

NEW STUDENT REGISTRATION FORM

Fill out the form carefully for registration

Student's Name*

First NameLast Name

Birth date*

DayMonthYear

Gender*

MaleFemaleOther

ID Card / Passport Number*

eg. 73xxxxxF

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number*

eg 021Phone Number

Current level*

Beginners Level)Intermediate LevelAdvance LevelOther

Date of Registration*

Date

Appointment

Parent/Guardian Information (if student is under 18)

Name

First NameLast Name

Mobile Number

eg 021Phone Number

E-mail

example@example.com

Alternative Emergency Contact

Emergency Contact's Name

First NameLast Name

Mobile Number

eg 021Phone Number

Does the student have asthma, allergies, or any other medical condition? If yes, please describe.

Membership

Membership type*

Annual membership of S$120.00New student's registration fee of S$50 including a training T-Shirt4 lessons per month8 lessons per monthUnlimited training: Up to 4 classes a weekPersonal instruction: Price as agreed

Payment option*

Cash - please make payment at beginning of classOnline payment - please request internet banking detailsMobile payment - please request mobile payment information

I understand that all sports carry a risk of injury and that Wing Chun Kuen Training Centre is not responsible for injuries or losses suffered as the result of parting in these activities.

From time to time Wing Chun Kuen Training Centre will post photographs of our students, instructors, and supporters online. I will let Wing Chun Kuen Training Centre know by email if I do not consent to my or my child's photo being shared.

Wing Chun Kuen Training Centre will give 30 days' written notice of any fee increase.

Medical Authorization

In the event of an injury or medical emergency, I allow Wing Chun Kuen Training Centre to provide first aid, arrange transport to a medical facility, and authorize emergency treatment as recommended by a doctor for the student named above.

I understand that all reasonable efforts will be made to contact the student's parent and/or emergency contact if an injury or medical emergency occurs.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature*

WING CHUN KUEN TRAINING CENTRE

Membership