Martial Arts Course Registration Form

One Unit CKC School of Martial Arts Registration

One form per student in household
Student Information
Student's Name*

First NameLast Name
Birth date*

DayMonthYear
Gender*

MaleFemale
Current level*

White belt (beginner)Intermediate belt (yellow-orange)Advanced belt (green-brown)Black beltSelf-Defense
Date*

MonthDayYear
Date
Parent/Guardian Information (if athlete is under 18)
Name*

First NameLast Name
Mobile Number*

eg 021Phone Number
E-mail*
example@example.com
Alternative Emergency Contact
Emergency Contact's Name

First NameLast Name
Mobile Number

eg 021Phone Number
Does the athlete have asthma, allergies, or any other medical condition? If yes, please describe.*
Membership
Acknowledgement I understand that all sports carry a risk of injury and that CKC One Unit School of Martial Arts is covered by liability responsiblility for injuries or loss suffered as the result of participating in these activities. From time to time CKC One Unit School of Martial Arts will post photographs of our athletes, coaches, and supporters online. I will let CKC One Unit School of Martial Arts know by email if I do not consent to my or my child’s photos being shared. CKC One Unit School of Martial Arts will give 30 days written notice of any fee increase.
Medical Authorization In the event of an injury or medical emergency, I allow CKC One Unit School of Martial Arts to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above. I understand that all reasonable efforts will be made to contact the athlete’s parent and/or emergency contact if an injury or medical emergency occurs.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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One Unit CKC School of Martial Arts Registration

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