Hulme Karate Club Membership form

Hulme Karate Club Membership form

One member per form
Member *

First NameLast Name
Member Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal Code
Contact Number
If under 16 parent/guardian
Email Address
example@example.com
MEDICAL INFORMATION

Please detail below any important medical information that our Sensei's / Instructors should be aware of (e.g. epilepsy, asthma, diabetes or allergies) Please do NOT leave blank - if there is no information please type 'None'*
NEXT OF KIN / EMERGENCY CONTACT
Name*

First NameLast Name
Contact Number *
Email*
example@example.com
Relationship to Member*
Which language do you speak?
STUDENT & PARENTAL / CARER AGREEMENT

By completing this form, I/we agree:
1. To the named member taking part in the activities of the club
2. That I have read and agree that my child will abide by the club code of conduct whenever present at club activities or competitions
3. I/We agree that my child(ren) will abide by the clubs Dojo Etiqutte whenever present at club activities or competitions.
4. I/We accept that the club can not be held responsible for the welfare of any student unless thet are in the main training hall (dojo)and in the presence of an instructor. This applies both before and after the lesson.
5. MEDICAL INFORMATION - It may be essential at some time for authorised persons acting on behalf of Hulme Karate Club to have the necessary authority to obtain urgent treatment which may be required whilst at representative club competition or training. Please sign below to give your consent to emergency treatment being given to the named Member on this form by any trained personnel*

AgreeDisagree
6. I/We Give Hulme Karate Club permission to use still and/or moving images being video footage, photographs and/or frames and/or audio footage depicting my/our children named above, for any of the following uses:Advertisement, Marketing, Leaflets, Social Media or any other use such as for Training, educational or publicity purposes for Hulme Karate Club and Karate Do.*

AgreeDisagree
Parent / Carer *

First NameLast Name
Signature of Parent or Carer *

Clear
Date*

DayMonthYear
You're Prefered training Day

Saturday 10:00am - 11:00amSaturday 11:00am - 12:00pmSaturday 12:15pm - 1:15pm (Adult only)
How did you hear about us?

Word of mouthSocial MediaInternet e.g GoogleAdvertisement e.g Banner or flyerCurrent memberOther
Welcome to Hulme Karate club.

To find out all the latest club information, please visit our website www.hulmekarateclub.co.uk
FOLLOW US ON SOCIAL MEDIA TO KEEP UPTO DATE
Should be Empty:

Hulme Karate Club Membership form

MEDICAL INFORMATION

NEXT OF KIN / EMERGENCY CONTACT

STUDENT & PARENTAL / CARER AGREEMENT

Welcome to Hulme Karate club.