Atlantic Karate • Shotokan Karate • Self Defence • Cornwall Karate • Newquay Karate • Cornwall Martial Arts • Newquay Martial Arts • Shotokan Karate • Shotokan Karate Cornwall • Karate Classes in Newquay

Student Name*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Gender*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Student (or Parent) E-mail*

example@example.com

Mobile Number*

Landline Number

Area CodePhone Number

Emergency Contact Name and No*

Grade*

Licence Number (in your Grading Book) OR YOUR FIRST FREE SESSION DATE IF NEW STUDENT*

Which Training Session are you trying to get into?*

PLEASE SELECT THE SESSION YOU WOULD LIKE TO ATTEND.

Permission for photos?*

YESNO

Consent to First Aid*

YESNO

Agree to Terms and Conditions*

YESNO (if no then you will not be able to attend)

Additional Comments

I am aware of the club (Atlantic Karate) terms and conditions and I am fully aware of the clubs policies which I fully agree to and will adhere to. On links below. https://www.atlantickarate.co.uk/newterms.html and also http://www.atlantickarate.co.uk/safeguarding-policies.html*

YesNo

I am aware of and will comply fully with the Parental Standards Agreement as published by Atlantic Karate - viewable on the following link - (http://www.atlantickarate.co.uk/safeguarding-policies.html)*

YESNO

I understand that me or my child may have contact with a staff member if required for first aid purposes– staff will have use of masks and gloves and relevant PPE*

YESNO

STUDENT REGISTRATION FORM

Atlantic Karate Terms