Team Mushin CIC

Membership Form

CLUB MEMBERSHIP FORM SENIOR/JUNIOR

N.B. Due to the new GDPR regulations Team Mushin CIC are required to obtain explicit consent to contact members, we have added these to the membership form. Team Mushin will only contact you about activities and services a member expects from us. This will allow us to let you know about new or changes to classes, products or services.

YOUR SURNAME (required):

YOUR FORENAMES (required):

YOUR ADDRESS (required):

YOUR E-MAIL (required):

CAN TEAM MUSHIN CONTACT YOU USING THIS EMAIL?
YesNo

YOUR CONTACT NUMBER:

CAN TEAM MUSHIN CONTACT YOU USING THIS CONTACT NUMBER?
YesNo

YOUR DATE OF BIRTH (required):

NEXT OF KIN DETAILS:

YOUR NEXT OF KIN (required):

NEXT OF KIN RELATIONSHIP (required):

NEXT OF KIN TELEPHONE NUMBER (required):

CAN TEAM MUSHIN CONTACT YOU USING THIS CONTACT NUMBER IN CASE OF AN EMERGENCY?
YesNo

NEXT OF KIN E-MAIL:

TRAINING DETAILS:

HAVE YOU EVER PRACTISED MARTIAL ARTS? (required):
YESNO

IF YES, PLEASE GIVE BRIEF DETAILS, INCLUDING AFFILIATION AND GRADE:

DO YOU HOLD A CURRENT MARTIAL ARTS LICENCE?
YESNO

CONVICTIONS:

HAVE YOU EVER BEEN CONVICTED OF A VIOLENT CRIME? (required):
YESNO

IF YES, PLEASE GIVE BRIEF DETAILS:

MEDICAL:

DO YOU SUFFER FROM ANY OF THE FOLLOWING - MIGRAINE, EPILEPSY, HAY FEVER, NERVOUS DISORDERS, HEART DISORDERS, HAEMOPHILIA, DIABETES, RESPIRATORY PROBLEMS (E.G. ASTHMA) OR ANY OTHER HEALTH DISORDERS? (required):
YESNO

IF YES, PLEASE GIVE BRIEF DETAILS:

DO YOU ACCEPT THAT PARTICIPATION IN MARTIAL ARTS AND SELF DEFENCE TRAINING INVOLVES THE RISK OF SERIOUS INJURY?(required):
YESNO

AGREEMENT:

BY SUBMITTING THIS FORM YOU HEREBY WISH TO BECOME A MEMBER OF THE ABOVE MENTIONED ACADEMY (TEAM MUSHIN CIC). YOU AGREE TO THE RULES AND NOTICES APPLICABLE TO THE ACADEMY; AND WILL UPHOLD THE SPIRIT AND TRADITIONS OF THE MARTIAL ARTS. YOU AGREE TO TEAM MUSHIN CONTACTING YOU IF YOU HAVE SELECTED YES IN THIS APPLICATION BY PHONE/E-MAIL AS CHOSEN ABOVE. YOU DECLARE THAT YOU ARE FIT TO TRAIN/COMPETE IN MARTIAL ARTS/SELF DEFENCE:

NAME (required):
TODAY'S DATE (required):
GUARDIANS NAME IF UNDER 18 (required):