Style
*
Karate
Kickboxing
Age
*
Adult
Junior
First Name
*
Surname
*
Place of Training
*
Name of school or venue where your class is held
Town
*
Date of First Class Attending
*
Medical Information
Has the person attending the class undergone any surgery within the last 6 months?
Yes
No
If ‘YES’ please add details in the box below
Has the person attending the class ever been diagnosed with any form of heart problem?
Yes
No
If ‘YES’ please add details in the box below
Does the person attending the class have any disabilities that are relevant for training?
Yes
No
If ‘YES’ please add details in the box below
Is the person attending the class currently taking any medication?
Yes
No
If ‘YES’ please add details in the box below
Does the person attending the class suffer from high blood pressure?
Yes
No
If ‘YES’ please add details in the box below
Does the person attending the class suffer from asthma?
Yes
No
If ‘YES’ please add details in the box below
Your Comments
Contact Info
Your contact details are solely for our use only and will never be shared with any third parties. They will only be used in the event of an emergency or to contact you with important information regarding your class. Your email address will only be used by us to be added to our SAMA email newsletter to keep you updated with the latest news and offers. If you would like to view our full GDPR privacy policy please click here
Contact Tel No.
*
Contact Tel No. 2
Email Address
Declaration
The person attending the class has never been convicted of any charge involving physical violence. They promise not to use any of the skills taught outside of the class except in practice, self defence or for law and order. They will not use their training to provoke an attack and promise to uphold the true spirit of the martial arts.
Please Note
SAMA Organisation is a private members club. SAMA Organisation has the right to terminate any membership if club rules are not upheld. SAMA organisation has the right to refuse membership and further training if we believe this is in the best interests of the student and/or the class. Whilst SAMA will do their best to accommodate individual needs, our instructors may refuse membership on the grounds of safety to other students and staff. Students with disabilities or health conditions are advised to contact us prior to attending to ensure suitability of karate or kickboxing training. All information on this form is held in confidence by the SAMA Organisation.
Occasionally photographs maybe taken by our staff at classes, events and our fun days and may be used on our social media pages. Please tick this box if you do not wish your child to appear in the photographs.
*
Please click here to say I hereby agree and confirm that all the information I have provided is correct and I have read and understand the information included within this form.