Enrolment & Indemnity Form
Students Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
School
*
Address
*
Street Address
Street Address Line 2
Town/City
State / Province
Postcode
Parent/Guardian
Next of Kin - In case of an emergency
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
How did you hear about us?
*
Confirmation
By signing this form, you permit your child (named above) to train under NXT Generation MMA, it's instructors or any member thereof, for any liability or damage, loss or injury of any sort whatsoever, which may arise from any activity in which he/she partake, relating to the said school.
I give permission for any images (electronic or otherwise) captured during any official activity (training, grading, etc.) to be used for the promotion of the above mentioned organisation in the UK and on Social Media.
*
Agree
Disagree
Any other information that we should be aware of?
Signature
*
Continue
Continue
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