New Student Registration Form

WING CHUN KUEN TRAINING CENTRE
NEW STUDENT REGISTRATION FORM

Fill out the form carefully for registration
Student's Name*

First Name Last Name
Birth date*

Day Month Year
Gender*

MaleFemale
ID Card / Passport Number*
eg. 73xxxxxF
Email*
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Number*

eg 021 Phone Number
Current level*

Beginners Level)Intermediate LevelAdvance Level
Date of Registration*

MonthDay Year
Date
Appointment
Parent/Guardian Information (if student is under 18)
Name

First Name Last Name
Mobile Number

eg 021 Phone Number
E-mail
example@example.com
Alternative Emergency Contact
Emergency Contact's Name

First Name Last Name
Mobile Number

eg 021 Phone 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*

Clear
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

WING CHUN KUEN TRAINING CENTRE

Membership