Name *

First Name

Last Name

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Date of Birth *

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HEALTH DECLARATION *

Are you aware of any health problems that you have that, in the interests of your safety, the academy/club should be advised of?

YES

NO

CONSENT *

I hereby certify and decree that all the information contained in the declaration above is true and accurate. By clicking "SUBMIT" on this form I agree to being added to the Kyokushin North Bondi database and Kyokushin Mailchimp mailing list. You will not be spammed, and can unsubscribe at any point.

I consent

DECLARATION OF UNDERSTANDING *

I fully recognise and understand that participating in martial arts in general, and Kyokushin karate in particular, can be dangerous.

I understand