Medical History: do you suffer from any of the following?
(If Yes please tick the box provided)
Registration Page.
You will have been given the URL for this page after visiting our club, please complete the registration form and submit as soon as possible for us to print off and have you sign. Please also submit if possible two passport size photographs either electronically or bring to the next lesson. This form will be used for both club registration and NAKMAS insurance so please make sure you check all details are correct.
Photograph submissions should be sent to Judo Club Admin
Thankyou for completing this form and welcome to
Maindee Judo Club
If you are uncomfortable with the filling out of the above form you can download the alternative version of the registration form to print off and return with you to the next lesson.
By submitting this registration form you are agreeing to the terms and conditions of Maindee and Duffryn Judo Clubs, and their rules. If you require any further information please contact the club by e-mail, or check out the F A Q
NAME
DATE OF BIRTH
ADDRESS
POST CODE
TELEPHONE NUMBER - inc std code.
EMERGENCY CONTACT - (NAME)
RELATIONSHIP TO STUDENT
(eg Mother, Father, Brother etc)
CONTACT NUMBER
E-MAIL ADDRESS
Have you broken any bones in the past 6 months
(if yes please give brief details)
Martial Arts History:
(have you ever practised a martial art? If so, please list details including grade achieved, date grade achieved and association/instructor)
Criminal History: Have you ever been charged or convicted with and crime or violence?
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If yes enter details here
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Denotes required fields.
Click on the files below, both files will have to be printed and submitted
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