Mini Cickers Registration

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BRIEF MEDICAL QUESTIONNAIRE (CONFIDENTIAL)

Do your child have any heart conditions, has a Doctor ever stated you should you should only do recommended exercises?
NoYes

Has your child ever had a serious illness?
NoYes

Has your child ever suffered a serious injury?
NoYes

Does your child have any pain in your chest when doing exercise?
NoYes

Does your child you have any bone or joint problems?
NoYes

Is your child taking any prescribed drugs?
NoYes

Does your child suffer from Asthma?
NoYes

Does your child use inhaler’s?
NoYes

Does your child suffer from hemophilia?
NoYes

Any special requirements your child may need whilst training?
NoYes

If you have answered Yes to any of the above please consult with you instructor and they may refer you to your doctor. You are obliged to inform your instructor should there be any changes to this at any time

Does your child have any previous experience of martial Arts?
NoYes

Do you agree for your child to abide with club rules presently in force and subsequent modifications/additions that from time to time are deemed necessary?
NoYes

Please indicate with a tick which aspect of Kickboxing/Fitness appeals to you most?

How did you find out ABOUT our club ?

As the child’s parent/guardian I indemnify the above club in respect of any injury caused to another member or against losses caused to the club by any act of theirs or default.

As the child’s parent I understand that the training and practice of the martial arts can be dangerous and agree to personally bear all losses caused by injury whilst my child is engaged in it.

As the child’s parent I understand that my child must use their new skills responsibly and within the boundaries of the law/school rules.

I allow my child's image to be captured and used on our Facebook site and social media.

Payments are by direct debit and once you have signed you/your child up, you will be contacted via Gocardless for payment by email.