HBK Karate Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form once for each person who may be interested in becoming a member.

This completed form will be emailed to the address provided. Please print the completed form and give it to the instructor when you arrive at your first session.

Someone will be in touch with you to discuss membership. You will not be registered as a member of the HBK Dojo until you confirm your interest by becoming a financial member.

Email *

Personal Information

Student's First Name *

Surname *

Date of Birth *

YYYY

Gender *

Male

Female

Contact Details

Contact Name (Parent or Guardian for kids)

Mobile Phone Number *

Other Phone Number

Street Address *

Suburb

City *

Postcode *

Any Other Contact Information

Training Preferences

Club *

Havelock North Scouts Hall, Havelock North; Frimley Primary School, 202 Frimley Road, Hastings

Havelock North

Hastings

Required

Class Type *

ABC (Absolute Beginners Class) 7yrs+

Graded Students

Personal Training

Fitness & Fight Class

Required

How often would you like to train? *

1 class per week

2 classes per week

3 or more class per week

How did you hear about HBK Dojo? *

Web search

Word of mouth

Another family member is training

Signage / flyer

Through school

Other:

Required

Acknowledgements *

Kyokushin Karate is a traditional Japanese martial art that requires intense physical exertion. Full contact fighting is a component of Kyokushin. While every effort is made to protect the comfort and safety of all students there is an inherent risk of pain and injury.

I understand and accept the risks

I understand that for the comfort and safety of myself and others I must abide by the dojo rules and follow instruction

I understand that every member and every parent/guardian of a member is expected to be vigilant to potential risk and contribute sensibly to the comfort and safety of all students.

Required

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms