Student Membership Application Form
(This membership includes annual licence and affiliation to Association of Classical Martial Arts)

  Application For:      Junior License       Senior License       Date of Application: 

  Full Name:      Date of Birth: 
  Address:
  
  Telephone Numbers: 
  Email:  
  Occupation: 
  Why do you want to learn karate ?
  
  Martial Arts or any relevant history in terms of body work ?
  

  Medical History: Do you suffer from any of the following? Please tick in the boxes provided:

  Allergies      Asthma      Diabetes      Epilepsy      Haemophilia      Hay Fever

  Nervous Disorder     Respiratory Disorder      Migraine      Joint/Skeletal      HIV

  Other  Please give Details
  

  Criminal History: Have you ever been charged or convicted with any crime of violence ? No 

  Yes  Please give Details.
  

Declaration
I declare that the above information is true and correct, and that I will abide by the policies and procedures as laid down by the EmptyHands KaraTe School. I accept that the practise of any martial art involves the risk of injury.

I enclose with this application; Annual membership fee: £20 (Payable before first grading)

  Signed (18 years+/Student):

 

Signed (Parent/Guardian of Students under 18):

Please hand this form to your Instructor/School Manager for approval process.

  Membership Registration Code:

 

Head Instructor/School Manager Signature: