SK Cobras Martial Arts Adults Registration
Please fill in the form below.
Member Information Section:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Number of students joining?
*
1
2
3
4
5
6
7
8
9
10
Student 1:
*
First Name
Last Name
Student Gender:
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of:
*
Student 2:
*
First Name
Last Name
Student Gender
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of
*
Student 3:
*
First Name
Last Name
Student Gender
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of
*
Student 4:
*
First Name
Last Name
Student Gender
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of
*
Student 5:
*
First Name
Last Name
Student Gender
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of
*
Student 6:
*
First Name
Last Name
Student Gender
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of
*
Student 7:
*
First Name
Last Name
Student Gender
*
Male
Female
Prefer not to say
Date of birth:
*
Medical information regarding this person that we should be aware of
*
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Emergency contact:
Second emergency contact.
Name
*
First Name
Last Name
Phone:
*
Relationship
*
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Package Options
Primary Package
*
SK Cobras Martial Arts - Adults £30.00 (monthly payment)
Other payment (please discuss with instructor first)
Additional Students
Additional Family Member(s) (SK Cobras) - Direct Debit (per sibling) - £25.00
Other
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Payment Information:
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Select payment method below
Payment Method:
*
Direct Debit
Cash
BACS
Other
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Select one- Photography agreement - from terms and conditions above
*
Agree
Disagree
Accept GDPR - from terms and conditions above
*
I agree
I disagree
This is required for submitting this form. If you select disagree you will not be able to complete your membership sign up through this form.
Marketing preferences from SK Cobras Martial Arts
General communications and newsletters
None of the above (please note this will mean we are unable to send you information relating to your students club or upcoming events)
Initials
*
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