Yamaji Dojo Martial Arts & Fitness Centre

**PLEASE UPLOAD A PHOTO OF THE STUDENT IN THIS FORM FOR OUR ATTENDANCE APP.**

Personal Information

FIRST NAME *

LAST NAME *

UPLOAD PROFILE PHOTO

ADDRESS LINE 1

ADDRESS LINE 2

TOWN/CITY

POSTCODE

EMAIL ADDRESS (PRIMARY) *

EMAIL ADDRESS (SECONDARY)

GENDER

PHONE NUMBER

MOBILE NUMBER

DATE OF BIRTH

Emergency Contact Information

NAME

RELATIONSHIP

PHONE

MEDICAL / ALLERGY NOTES

You'll be joining:

JUJUTSU KIDS

Which location(s) do you want to enrol at? *

HEAD QUARTERS - KV

SUSSEX

Enter payment details for this plan

Jujutsu 1 Class per week

$51.75 / MONTH

Please read and sign the following agreements

WAIVER

Yamaji Dojo Martial Arts & Fitness Centre

Personal Information

Emergency Contact Information

You'll be joining:

Which location(s) do you want to enrol at? *

Enter payment details for this plan

Jujutsu 1 Class per week

Please read and sign the following agreements

Success!

Hmm...

Yamaji Dojo Martial Arts & Fitness Centre

Personal Information

Emergency Contact Information

You'll be joining:

Which location(s) do you want to enrol at? *

Enter payment details for this plan

Jujutsu 1 Class per week

Please read and sign the following agreements

Which contact methods do you consent to?

Success!

Hmm...