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ENGLISH SHOTOKAN ACADEMY
CLECKHEATON KARATE CLUB
APPLICATION FORM

IF YOU ARE INTERESTED IN JOINING CLECKHEATON KARATE CLUB
PLEASE FILL IN YOUR DETAILS BELOW IN THE RELEVANT BOXES
AND PRESS THE SUBMIT BUTTON AT THE BASE OF THE PAGE

IMPORTANT:
IF YOU ARE UNDER THE AGE OF 16, THIS FORM MUST BE FILLED IN FOR YOU
BY YOUR PARENT OR GUARDIAN

APPLICANT'S DETAILS: I am under 16 I am over 16

Mr Mrs Miss Ms

FIRST NAME LAST NAME

Address

Postal Code

Telephone Email


PLEASE READ THE FOLLOWING:
Any information you give us is intended solely for the use of Cleckheaton Karate Club and is not to be supplied to third parties. If you are interested in joining the club, after 3 lessons you will be required to complete an ESA LICENSE AND MEMBERSHIP FORM.

If you experience any difficulties with this form, you can EMAIL your details to info@cleckheatonkarate.co.uk
OR YOU ARE WELCOME TO JUST CALL IN AND VISIT US AT ONE OF OUR TRAINING SESSIONS

POINTS TO CONSIDER:
Are you healthy and do you suffer from haemophelia, asthma, coronary heart disease, diabetes, high blood pressure or fever?

Have you recently suffered a bone fracture, major operation, torn muscle or sprains?

Do you currently suffer from back/neck pains in any joint, rheumatism or arthritis?

Has a medical practitioner at any time advised you not to participate in any physical exercise programme or sporting actvity?

THESE QUESTIONS WILL BE ASKED IN THE ESA MEMBERSHIP APPLICATION AND IF ANY ARE APPLICABLE TO YOU, IT SHOULD BE MENTIONED TO THE CLUB SECRETARY OR INSTRUCTOR.

PLEASE REFER TO CONTACT PAGE FOR TRAINING TIMES, CLUB FEES AND OTHER DETAILS

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