Application Form

Print registration form

Student Membership Application Form

(This membership includes; annual licence, public liability insurance & accreditation to the Karate Society)

Application For:*
Date of Application:
Name
Date of Birth:
Address:
Telephone Numbers:
Email:
Occupation:
Do you have any type of learning difficulty?
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:
Criminal History:
Have you ever been charged or convicted with any crime of violence ?
Create login
Please enter the following details to create a username and password.
Declaration I declare that the above information is true and correct. I abide by the terms & conditions of EmptyHands KaraTe School (please refer to your licence page for Ts&Cs). I accept that the practise of any martial art involves the risk of injury.
Please select what you would like to do:
 
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