MTC Ringwood Membership Updating Form

MTC RINGWOOD

10 Maroondah Highway,
RingwoodVIC 3134

info@martialarts.com.au

www.martialarts.com.au

(03) 8806 9374
BJJ

Summer Holiday Program

Time to LEVEL UP!

See posters and website for details or contact us for more information.

Monday 13th of January - Friday the 17th of January

INCLUDES stripe gradings (Save $75)

Please note:

Attendance & participation is required on all days to be eligable to grade.

Once booking is received, payment invoice and details will be emailed to you.
BJJ 13th - 17th of January, Monday to Friday

BJJ for Kids (8 to 12 years): 5:00 - 6:00PM - $195BJJ JNR/SNR: 6:00 - 7:30PM - $225
Family Discount (each family member must fill out the form)

2 members 10%3 members 20%4+ members 30%
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
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