Kyu Shin Do Aikido Registration form

Kyu Shin Do Aikido Membership Application

Personal Information

Please complete the personal information below. Required information is indicated by *

First Name: *

Last Name: *

Date of Birth *

Address: *

City: *

Post Code

Mobile: *

Home Phone:

Email: *

Contact Person

(only required if under 18 years of age)

Contact First Name:

Contact Last Name:

Contact Mobile:

Contact Email:

Martial Arts Experience

(Optional - details of any previous martial arts training of more than 6 months)

Martial Arts Experience

Aikido Grade

Grade Issued By

Health Issues

(Optional - anything instructors should be aware of for your safety)

Health Issues:

Declaration

I agree to abide by the constitution and rules of Kyu Shin Do Aikido (North Shore) Incorporated.
I acknowledge that the organisation accepts no responsibility for injuries sustained as a result of my practicing Aikido.
If I decide to join my auto payment for mat fees will commence after 2 free classes

Use of images

From time to time we publish photos of our members on publicly available material (our web site and facebook page) and in training material available to other members.
We are careful to show individuals positively and, on request, would remove any image a member is unhappy with.
We will only use your image if you consent to us doing so.

Tick the checkbox if you agree to the declaration above.

Tick the checkbox if you consent to use of images