Name *

First Name

Last Name

Phone *

(###)

###

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Medical History

Please place a mark to any of the following which may apply to you (and or your children)

has the participant ever had any heart trouble?

has the participant ever fainted or had any blood pressure issues?

has the participant ever been diagnosed with Asthma?

has the participant ever had any bone or joint problems?

is the participant over the age of 65yrs?

is there any custody arrangements or court orders issued in relation to yourself or your child? *

Yes

No

KSK Livestreams

At KSK Dojo's we try to run a livestream of our classes for members parents to watch, and for members to reveiw at a later time. Our livestreams are stored in our Vimeo database accessible from the members area of this website. These records are not for public consumption and will not be used by KSK for any promotional purposes. Please mark "yes" that you acknowledge your participation, or "no" if you do not want yourself or your children to be seen on the livestream.

Yes

No

TERMS AND CONDITIONS *

I hereby apply to take part in Karate Training at KSK Dojos, here after referred to as the CLUB, and certify that all information supplied by me is correct. I certify that I am/my child, is in good physical health and acknowledge that for the duration of the time I am/my child is on the CLUB premises both my propery and my person shall be at my own risk, and I will not hold the CLUB, its members, staff and or officials liable for any loss, damage or personal injury. Please acknowledge yes or no

YES

NO

Today's Date *

Please complete the date in which this form was completed.

MM

DD

YYYY