Registration

Welcome to our dojo. We really happy to have you join us and excited to help you progress and enjoy your training with us.

If the student is under 18, please have a parent or guardian fill in the form on their behalf.

Student Name

First Name

Last Name

Parent/Guardian Name

If relevant

First Name

Last Name

Please fill in the rest of the form with answers relevant to the student

Date of birth

YYYY

Gender

Address

Phone

(###)

###

####

Date of registration

YYYY

MEDICAL INFORMATION

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

2. Do you feel pain in your chest when you do physical activity?

3. In the past month, have you had chest pain when you were not doing physical activity?

4. Do you loose your balance because of dizziness or do you ever lose consciousness?

5. Do you have a bone or joint problem that could be made worse by physical activity?

6. Are you currently taking any medication?

7. Are you pre/post natal?

8. Do you suffer from asthma or breathing difficulties?

9. Do you suffer from diabetes or epilepsy?

10. Do you have any sports injuries?

11. Have you ever suffered from neck or back problems?

12. Is there any good physical reason not mentioned why you should not participate in physical exercise?

Do you have any other health, allergy or medical problems of which your instructors should be aware?

If yes, please give details

EXPERIENCE

Previous Martial Arts Experience

Give details if you have, but don't worry if you don't have any as most don't

Previous Kyokushin Experience

If you have already trained with the BKK or IFK please give details below including , if you have them, you BKK or IFK Licence numbers

Previous Fitness Experiences

If you have any fitness experience or achievements you'd like to share, please give details here

DECLARATION (signature)

Declaration

I confirm the above details to be true at the time of writing

Thank you!