Junior Samurai Trial Lesson Registration Form Please enable JavaScript in your browser to complete this form.Child's name *FirstLastDate of birth *Age *Gender *MaleFemalePreferred trial class days (we offer a free week of trial classes and recommend attendance of at least 2 classes)Tuesday (4.00pm – 4.45pm)Wednesday (4.45pm – 5.30pm)Thursday (5.15pm – 6.00pm)How did you hear about us?Social Media (Facebook, Twitter, Instagram etc)School NewsletterFlyers/BannersFriends/FamilyGoogle SearchVan/SignHas your child ever been restricted or denied from participating in physical activity, sport or martial arts for any reason? *YesNoDoes your child have any on-going medical conditions? If so, please identify it below: *AsthmaAnaemiaDiabetesInfectionsOther: Please specify belowNoneOther:Has your child ever had an injury to a bone, muscle, ligament or tendon that has caused him/her to not participate in physical activity, sport or martial arts? *Yes (please specify the injury type and/or restrictions below)NoInjury type and restrictions:Has your child ever felt faint or had spells of dizziness during physical activity/exercise that causes him/her to lose balance? *YesNoDoes your child have any muscle, bone or joint pain or soreness that is made worse by particular types of activity? *YesNoIs there any other medical or physical conditions/limitations that we should be made aware of before your child participates in our martial arts classes? (write 'None' if none) *Some medical conditions may require the provision of a medical clearance prior to training. I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. By ticking the box, I hereby agree to all terms and conditions as mentioned and release Kids Martial Arts Academy and all instructors and representatives from any liability, for personal injury which may occur to my child during his/her participation in classes. *I agree to the Terms and Conditions above.Today's date: *Parent's name *FirstLastMobile number *Email *MessageSubmit
