🥋 HWJC - Payment Advice Form

HWJC - Payment Advice Form 2024
All participants must have an active BJA licence. Review your licence by accessing the British Judo Association Membership portal, The Dojo.

Note: parents/legal guardians of multiple siblings are required to fill in a form for each participant.
Date

DayMonthYear
Participant Details: Parental Consent required for participants under 18.
Confirm Session/s*

Newaza Night (Mon 8:15 to 9:45pm) Age 13+Junior Judo (Tues & Thurs 6:45 to 7:30 pm)Intermediate & Advanced Judo (Tues and Thurs 7:30 to 8:30pm)Advanced & Senior (18+) Judo (Tues and Thurs 8:30 to 9:30pm)England Talent Development Centre (ETDC) THURS
Participant’s Full Name*

First NameLast Name
Parent/Legal Guardian Name

First NameLast Name
Contact Details-Email*
example@example.com
Contact Details - phone number*
Emergency Contact Details - phone number
Required for all Senior registrations
Payment Options*

I have set up a Standing Order on the 1st of each month for £35 (Juniors) or £40 (Intermediate, Advanced & Seniors)I will transfer the PAYG mat fee of £10 per session (visitors only)I will transfer the PAYG mat fee of £5 per session (EPP judoka only)
British Judo Licence Details: applicable to all visitors & non-HWJC judoka.
Date of Birth

DayMonthYear
Date
BJA Licence Number
BJA Grade
If not Novice
BJA Licence Expiry Date

DayMonthYear
Date
BJA Club
I confirm that I will submit a new form if there are changes to these responses and I will notify judocoaches@hwjc.co.uk as soon as possible.*

YES
Signature of Participant or Legal Guardian*

Clear

PAYG Judo Mat Fee - Credit Card payment applicable to all visitors

PAYG Mat Fee £10 (visitors only)

£10.00 Quantity

PAYG Mat Fee £5 (EPP judoka only)

£5.00 Quantity

Total

£0.00

Credit Card

Should be Empty:

HWJC - Payment Advice Form 2024

Credit Card