MTC Ringwood Membership Updating Form

MTC RINGWOOD

10 Maroondah Highway,
RingwoodVIC 3134

info@martialarts.com.au

www.martialarts.com.au

(03) 8806 9374
MTC School Holiday Program

LEVEL UP!

See posters and website for details or ask reception for more information.
Choose your Program/s*

Taekwondo - 11 to 15 December 2023BJJ and Boxing - 22 to 25 January 2024
BJJ/Boxing School Holiday Program*

BJJ (4-8 years): 4:00 - 4:40pm - $80BJJ (9+ years): 4:45 - 6:10pm - $125Boxing (9+ years): 6:15pm - 7:10pm - $100BJJ & Boxing (9+ years): 4:45pm - 7:10pm - $200 (save $25)
Membership Type

Current MTC MemberNew to MTC
Personal Information

For the person attending the program.
Full Name*

First NameLast Name
Preferred Name/Nickname
Date of Birth*

DayMonthYear
Date
Gender*

MaleFemaleOther
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Address

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Emergency contact name and number (if different from parent/guardian)*
Parent/Guardian Information for under 18 year olds
Parent/Guardian Full Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Are you interested to try other Martial Arts styles with MTC?

YesNo
If yes, which style would you like to try?
Health Declaration

Member's medical details
1. Are you taking prescribed medication which may impair reaction time or judgement?*

YesNo
If yes, give details:
2. Have you suffered any incapacity requiring medical attention in the past 12 months?*

YesNo
If yes, give details:
3. Do you have any pre-existing health conditions, or have any injuries/health concerns which may affect your training in martial arts?*

YesNo
If yes, give details:
4. Do you suffer from any known allergic reactions?*

YesNo
If yes, give details:
Submission made by

Clear
Date Signed

DayMonthYear
Date
Should be Empty:

Personal Information

Parent/Guardian Information for under 18 year olds

Health Declaration