Please fill out the following membership form to join or to to update your details if any have changed:
New or Existing Member?
NewExisting
First Name:
Last Name:
Your Email:
Your Date Of Birth:
Mobile Number:
Home Number:
Address:
Postcode:
Grade in Kore Kickboxing?
None10th Kup White Belt9th Kup White & Yellow Belt8th Kup Yellow Belt7th Kup Yellow & Green Belt6th Kup Green Belt5th Kup Green & Blue Belt4th Kup Blue Belt3rd Kup Blue & Red Belt2nd Kup Red Belt1st Kup Red & Black BeltBlack Belt 1st DanBlack Belt 2nd DanBlack Belt 3rd DanBlack Belt 4th DanBlack Belt 5th DanBlack Belt 6th Dan
Graded in any other style?
NoYes
If "Yes" then please supply the grade:
If "Yes" then please supply the style:
Emergency Contact Name: (Parent/Guardian for <16)
Emergency Contact Number:
Emergency Contact Relationship:
Do you suffer from any medical conditions?
If "Yes" then please supply information:
Any Criminal Record Other Than A Driving Conviction?
Any Additional Information?:
Do you accept the following? You will adhere to the Rules & Regulations. The practice of Kickboxing involves the risk of injury.
Certification I certify that the information provided is correct and true to the best of my knowledge.
- Fees, or portions of fees paid, are non-returnable, and non-transferable. - The club may be closed under certain conditions e.g. Public Holidays, Gradings, etc. - The club reserves the right to decline application or discontinue membership without reason. - Written medical clearance may be required for some medical conditions. - Under 16's must have a parent or guardian must meet with an official from the club.
Receive ocassional email information from Kore Kickboxing?
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