Student Introduction – KMA ST MARYS

Thank you for choosing to take up our free 1-week trial.
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 *

Age

Street Address

Suburb

Post Code

Phone *

Email Address *

Parent/Guardian details (if under 18)

Parent/Guardian Full Name

Phone

Relationship

Class Days

Little Dragons 4-6 yr old – Monday – Thursday
Champion kids 7-12 yr old – Monday – Thursday
Adults 13+ – Tuesday and Thursday

Select Trial Class Date

Please choose your preferred training days: *MondayTuesdayWednesdayThursday

IS THERE ANY MEDICAL CONDITION WE SHOULD BE AWARE OF? *NoYes

Please Specify:

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

Acknowledgement

Signature *

Date *