Student Registration Form for Karate Classes

Student Registration Form for Karate Classes

Please fill out your details to enroll in Karate classes at Karate Darwin.
Applicant's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Name (if under 18)

First NameLast Name
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list any medical conditions or allergies
Are you prescribed drugs which may impair reaction time or judgment?
If yes, what drugs? Please specify.
Have you suffered any incapacity requiring medical attention in the past 12 months?
If yes, give details.
Name and identify any physical impairments, injuries or medical condition that currently affect you
Are you aware of any health problem that you have that, in the interests of your safety, the academy/club should be advised of?
If yes please describe.
Please read the following terms and conditions carefully before proceeding. By continuing, you agree to abide by all the rules and regulations stated herein. [Insert the full terms and conditions text from your PDF here.]
Martial Arts Is Dangerous: Please read and understand the following statement carefully before proceeding.

Have you studied martial arts before?
Style
Grade Achieved
Number of years studied
Name of your instructor
Have you ever been excluded from Martial Arts in the past by a medical practitioner or any other person or entity or a Martial Arts Club?
If yes, provide details

Date

MonthDayYear
Date
Applicant Signature
Witness Signature
Name of Witness (Print in Block Letters)
Guardian's Consent
Guardian Signature
Relationship to Applicant
Guardian's Full Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
015883 Account Number: 467179569 Darwin Shotokan Karate. Please use details above for registration and lesson fees if you prefer. Cash is also accepted at the school dojo.
Our venue is at Sanderson High School, 60 Mathews Road, Malak, Darwin.
Annual Membership
$200 / year

Mandatory for all students
Includes official karate uniform (gi)
Covers insurance & registration
Required before attending classes
NT Sports Voucher accepted
Training Fees
$10 / lesson

Pay per class attended
Membership required first
Affordable for families
NT Sports Voucher accepted
NT Sports Voucher
Accepted

Use your NT Government
School Sports Voucher
For membership AND lessons
Makes training affordable for families

. Grading Fees Apply During Grading Weeks Usually Once Every Term. The Applicant will pay on demand the prescribed or stated fees for the service.
Medical Conditions: The Applicant warrants that he or she has not at any time suffered any blackout, seizure, convulsion, fainting or dizzy spells and is not presently receiving treatment for any illness, disorder or injury which would render it unsafe for the Applicant to take part in Martial Arts. The applicant further warrants that he/she has provided information on any and all pre-existing medical conditions.
Exclusion of Applicant: The Applicant warrants that he or she has not at any time been excluded from Martial Arts by a medical practitioner or any person or entity including a Martial Arts Club.
Rights of a Consumer: If the ‘Competition and Consumer Act 2010’ or similar state laws apply to this agreement then certain terms and rights may be implied into this contract.
Please read the following terms and conditions carefully before proceeding. By continuing, you agree to abide by all the rules and regulations stated herein. [Insert the full terms and conditions text from your PDF here.]
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Student Registration Form for Karate Classes

Guardian's Consent