Student Introduction – KMA ST MARYS

Thank you for choosing to take up our free trial comprising of 2 classes within 2 weeks.
Please fill out Student details below and preferred days.

This registration covers the student named for the trial period only, there is no obligation to join but if you do, our offer to you includes free uniform and free registration.

Student Details

First Name *

Last Name *

Date of Birth *

Street Address *

Suburb *

Post Code *

Phone *

Email Address *

Parent/Guardian details (if under 18)

Parent/Guardian Full Name

Phone

Relationship

Please choose your preferred training days: *MondayTuesdayWednesdayThursday

DO YOU HAVE ANY PREVIOUS MARTIAL ARTS EXPERIENCE?YesNo

What style have you trained in?

Please Specify:

Note: If any items are ticked a medical certificate is required clearing you to participate in Martial Arts.

Acknowledgement

Signature *

Date *