Osaka Kwai Judo Club - Contact info

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Contact Information New and exisiting members

Judokas Name *

Date of Birth *

YYYY

Judoscotland Membership Number (Existing members only)

Judo Scotland Membership Expiry Date

YYYY

Home Address *

Landline/Main Contact No *

Email *

Emergency contact Name (Contact1) *

Emergency contact Relationship to Judoka (Contact1) *

Emergency contact Telephone Number (Contact1) *

Emergency contact Name (Contact2) *

Emergency contact Relationship to Judoka (Contact2) *

Emergency contact Telephone Number (Contact2) *

Medical History or Allergies the Club should be made aware of: if yes please give details (if none please put NA) *

Grade Listing (Club Use only)

Grade Awarded (Club Use only)

YYYY

I Give Osaka Kwai Judo Club Permission to take photographs and/or video my child *

Yes

Required

I grant Osaka Kwai Judo Club full rights to use these images , and any reproductions of the images for fund raising, publicity or other purposes to achieve the Clubs awareness and promotion within the Judo family. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, the clubs website and funding applications. *

Yes

Required

In accordance with Judo Scotland's legislation, all coaches are First Aid Trained. I give permission to Osaka Kwai Judo Club to administer basic First Aid should it be required. *

Yes

Required

Parent/Guardians/Seniors Electronic Signature and date *

Submit

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