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Please complete this form in full and in BLOCK CAPITALS
Who introduced you to the club? ¨ Website ¨ Friend ¨ Flyer ¨ School ¨ Other ....................
CLUB: ¨ Beckenham Spa ¨ Bellingham ¨ Downham ¨ Kidbrooke ¨ Lewisham/Lee
¨ Mottingham ¨ Park Langley ¨ Tubbenden ¨ Warren Rd.
Membership: ¨ New ¨ Renewal [Expiry of last licence: ….…./….…./….….]
Please Note that Annual Licence /Insurance is NOT refundable
and must be completed by your 3rd session (1 passport sized photo required)
¨ Male ¨ Female
First Name .......................................................
Surname .........................................................................
Address .....................................................................................................................................................
Town/City .............................................................. Post code ...................................
Contact Number .................................................
Emergency Number ....................................................
E-mail .......................................................................................................
Nationality ...............................
Date of Birth ................................................ Age .................................
School Year .................................
Do you have any disabilities / health / learning issues which you think might affect your participation in this training program? ¨ No ¨ Yes ............................................................
Any previous Martial Arts experience? .......................................................................................................
Have you ever been convicted of a crime? ¨ No ¨ Yes ....................................................................
I give consent -
For my child to participate in Karate lessons ................................................. ¨ Yes ¨ No
For First Aid to be carried out on the member named above if required......... ¨ Yes ¨ No
To be contacted by E-mail .............................................................................. ¨ Yes ¨ No
To be added to the ‘WhatsApp’ group ........................................................... ¨ Yes ¨ No
NB: If you are added to the ‘WhatsApp’ group (as a member over 18 years old or a parent of a club member) for club updates, and you leave the club then it is your responsibility to leave the group.
Occasionally Photos may be taken of members during training sessions for use on :
Club Website ¨ Yes ¨ No Club Facebook page ¨ Yes ¨ No Club What’s App ¨ Yes ¨ No
Please Note all personal information will be kept secure under the GDPA Data Protection Laws (2018). Information will only be shared within the Association to assist with your training and safety and held while you are a member of the club. By signing this consent form you are agreeing to the TKI holding your information as long as necessary.
Signature of Applicant or Parent/Guardian if under 18 yrs
................................................................................
For Office Use Only
Name of Club ................................... Accepting Instructor.................................... Date ……../……../……..
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