UK Karate Club

Child Name*

Group / Class Name*

Year Group*

Height*

Day Dojo*

Mr / Miss*

First Name *

Surname *

Post Code

Address *

Date of Birth *

Mobile No *

Telephone No *

Email*

Membership Start Date*

Does the applicant suffer from Astama*

Please mention any disabilities*

Does the applicant wear Glasses/Lenses*

Please mention anything else that you think may help the instructor during coaching. (i.e. shy,lacks confidence etc.)*

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