LICENCE APPLICATION

LICENCE APPLICATION

Strike Taekwondo Skipton
NAME (student 1) *

First Name Last Name
(s.2)

First Name Last Name
(s.3)

First Name Last Name
DATE OF BIRTH (s.1) *

Day Month Year
Date
(s.2)

Day Month Year
Date
(s.3)

Day Month Year
Date
Email *
example@example.com
ADDRESS *

Street Address

Line 2

City

Post Code
EMERGENCY CONTACT *
Name and telephone number of a person to contact in case of an emergency
MEDICAL INFORMATION
Please provide details of any medical conditions, or any medication taken on a regular basis.e.g. Hayfever, Asthma, Diabetes, etc, or None.
Do you consent to a member of staff at Strike Taekwondo providing medical treatment if required? *
PHOTOGRAPHY / MEDIA *
Do you consent to Strike Taekwondo taking photographs / videos to be used in publications and / or other media, including but not limited to: the club website, social media pages, brochures, newspapers etc. Note: to ensure privacy of individuals, individuals (including any children), will not be identified using full names or personal identifying information without having first been authorised to do so by the individual or the parent/carer responsible for the child.

LICENCE TYPE *
Please select
LICENCE RENEWALS

Day Month Year
Please tell us the expiry date of your current licence

PURCHASE / RENEW LICENCE *

Licence - JUNIOR/ADULT (age 16+) 12 month membership and insurance for 1 adult. 10% discount for each additional licence purchased at the same time.

£ 28.00 GBP Quantity
Item subtotal: £ 0.00 GBP

Licence - CHILD (under 16's) 12 month membership and insurance for 1 child. 10% discount for each additional licence purchased at the same time.

£ 23.00 GBP Quantity
Item subtotal: £ 0.00 GBP

Total

£ 0.00 GBP

TERMS & CONDITIONS *
Do you agree to the terms and conditions set out by Strike Taekwondo.
Should be Empty: