Membership Application

Surname___________________Given Name____________________

Address_____________________________________________________

E-mail Address______________________________________________

Phone Number________________    D.O.B._______________________

Do you suffer from any illness or physical condition that may

Prevent you from taking part in karate and physical

Exercise?       Yes     No

If so please give details__________________________________________________________________

_____________________________________________________________________________________________

I/We clearly understand that the instructors volunteer their Knowledge and that no claim shall be taken against the club or its instructors or members in respect of any injury or loss arising from any activities carried out on the premises or Any other meeting place of the club. I/We understand this and accept this. I/We will act in a thoughtful and courteous manner at all times. I have read and answered and understand all of the questions above and hereby apply for membership of the Bushido Karate Club for myself/son/ daughter.                   

Signature of applicant or guardian_________________________

                                                Date__________________________