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Karate Registration Form
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How did you find out about JSMA?
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Website
Just Play
Social Media
Google
Supermarket Flyers
Other:
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Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Class
*
Choose
5 - 8 Years Old
9 - 13 Years Old
14 - 17 Years Old
Below 5 Years Old
Date of Birth
*
MM
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DD
/
YYYY
Language/s spoken
*
Your answer
Nationality
*
Your answer
School
*
Your answer
Previous karate experience
*
Yes
No
Please specify any relevant medical history (If applicable)
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Fathers Full Name
*
Your answer
Father's Occupancy
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Father's Number
*
Your answer
Father's Email
*
Your answer
Mother's Full Name
*
Your answer
Mother's Occupancy
Your answer
Mother's Number
*
Your answer
Mother's Email
*
Your answer
By registering I agree to abide by JSMA 's Dojo etiquette, rules, & regulations.
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