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
ADDRESS
*
Street Address
Line 2
City
County
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?
*
Please Select
YES, of course!
No, I do not wish for medical treatment to be administered.
PHOTOGRAPHY / MEDIA
*
Please Select
YES, that's fine!
NO
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.
Back
Next
LICENCE TYPE
*
Please Select
NEW
RENEWAL
Please select
LICENCE RENEWALS
-
Day
-
Month
Year
Please tell us the expiry date of your current licence
PURCHASE / RENEW LICENCE
prev
next
( X )
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
1
2
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
1
2
3
Item subtotal:
£
0.00
GBP
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
TERMS & CONDITIONS
*
Please Select
YES, I agree.
Do you agree to the terms and conditions set out by Strike Taekwondo.
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm