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Application Form

Applicant Details

Would You Like To Join The Club Whatsapp Group?
Yes
No

Emergency Contact Details

Medical Details

Does the applicant suffer from any medical condition which may affect their ability to train?
Yes
No
Does the applicant have any additional needs which we should be aware of?
Yes
No
Is the applicant currently seeing a doctor for any medical conditions?
Yes
No

Medication

Does the applicant currently take any prescribed medicines on a regular basis?
Yes
No

Please note it is the responsibility of the member or parent/guardian as applicable to inform Kesien Judo Club of any future medical/additional needs that affect the members ability to train or that we should be aware of.

Media

Photographs and videos may be taken by a person authorised by Keisen Judo Club. these photographs may be used in promotional literature, on the website/social media and for announcements of events concerning the club or press.

Do you give consent for photographs / videos to be taken of my child by Kesien Judo Club?
Yes
No
Do you give consent for photographs / videos to be used for promotional and publicity purposes?
Yes
No

Judo is a contact sport and carries certain risks, Keisen Judo Club cannot be held responsible for any injures arising from the participation in judo at its dojo or events.

Date
Day
Month
Year

Contact Us

Contact

Ashurst Wood Primary School

School Ln, Ashurstwood, East Grinstead RH19 3QW

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Tel: 07906362678

Email: judo.keisen@gmail.com

Thanks for submitting!

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