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Kuantan Taekwondo Academy

SSM-CA0081730-H Kukkiwon Membership System - MY000064
Name

First NameLast Name
Gender

MaleFemale
Date of birth

MonthDayYear
Date
MyKad/MyKid number
Occupation

StudentWorkingOther
Company name
Job title
Name of School / College /University
Darjah / Tingkatan
Phone Number
Please enter a valid phone number.
Do you have any other previous martial art experience? If yes, please state the martial art and level of expertise
Are you / your children / ward suffering from any disease / illnesses, etc , please specify below :
PARENT'S / GUARDIAN'S DETAILS

for students under 18 years old
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
E-mail*
example@example.com
Attached together with this application are as follows:

Registration/ Annual fee (once a year) RM20Monthly fee RM50Copy of NRICTaekwondo Uniform 'Dobok' RM100++(compulsory for new members)
*Monthly fee to be submitted to the instructor by the first week of every month. Classes will be cancelled on Public/festival Holidays without replacement

I acknowledge that the details given above is true and correct to the best of my knowledge. If my application is accepted, I agree to adhere to the rules, terms & condition and regulations enforced by Kuantan Taekwondo Academy from time to time. I also agree not take any action, legal or otherwise against the said Academy, its members, Clubs , Associations , Schools , Instructors, etc for any injury to me, my children/ward during and/or after the the training sessions.
Signature by Applicant above 18 Years ofage/ Parents / Guardian

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For further enquiries, contact:
Michael Tan: 014 608 2268
Chris Tan : 014-9055282
Agnes Too : 016-9380268
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Kuantan Taekwondo Academy