Personal Details

Student Name

Parent/Guardian Name (If student is under 18)

Address

Email Address

Phone Number

Alternate Phone Number

Date Of Birth

Emergency Contact Details

Emergency Contact Name

Emergency Contact Number

Alternate Emergency Contact Name

Alternate Emergency Contact Number

Medical Information

Do you have any specific medical conditions which could affect your karate training?

Details of any medication required

Any changes to your health or medical condition must be brought to the attention of the instructor.

Any information given will be treated with the strictest confidence, and only shared with other club instructors or assistants as required

Photography

Randori Shotokan Karate Club may take official images or videos of events, such as training, gradings, competitions, seminars, etc.

These images will be held by the club and could be used on the club website, social media, or for other forms of publicity.

Please confirm below if you consent to image being used of yourself/your ward:

Please Read The Following

- I can confirm that, to the best of my knowledge, all the answers given are accurate and true.

- I recognise and agree to abide by the rules and regulations of the club and of the HDKI GB.

- I recognise and agree that the instruction given is in good faith, and that the purpose of training is to improve my Karate, fitness, and knowledge for the participation of Shotokan Karate.

- I recognise and agree that due to the nature of martial arts, physical contact can occur and although every effort is made to avoid injury, accidents can happen.

- I recognise and agree that the instructor cannot be held responsible for any injury received during training, on courses, or in competition

- By pressing the SUBMIT button below, I am agreeing to all the above.