Icon Taekwondo Membership & Registration

ICON TAEKWONDO ACADEMY REGISTRATION & MEMBERSHIP

Welcome to Icon Taekwondo

Please complete the form below in detail as it provides us with vital information for our students.

Upon the completion of this form the lead instructor will process insurance and registration for your child for the year.

Should you have any questions, please contact Michelle who will gladly assist you.
Contact Information
Student Name

First NameLast Name
Date of birth

MonthDayYear
Date
Age
Male or female

MaleFemale
Address Information
Address

Street Address

Street Address Line 2

CityState

Postal
Parent's Information:
Parent's/Guardian's name
Phone Number
Please enter a valid phone number.
Mobile
Email
example@example.com
Parent's/Guardian's name
Phone Number
Please enter a valid phone number.
Mobile
Email
example@example.com
Emergency Contact 1

In the event of an emergency, please contact:
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Emergency Contact 2

In the event of an emergency, please contact:
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Medical Information- Please share any relevent information for the student that may require adaptive support during sessions. This should also include any injuries or special need requirements:
I consent to the student attending and taking part in Taekwondo Sessions

Yes
I understand that Taekwondo Martial Arts involves phyical activity and all students may be at risk of injury.

Yes
I am happy for Icon Taekwondo to process membership and Insurance registration for the student. In line with British Taekwondo and Safeguarding. The lead instructor has explained the insurance and membership process.

Yes
I give permission for Icon Taekwondo staff to admit first aid or seek medical attention in the case of an emergency.

Yes
I give permission for Icon Taekwondo Academy to take photos, videos for the use of promotional purposes only
Signature of Parent:

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Date

MonthDayYear
Date
Should be Empty: