PaulM Taekwon-Do
Taekwon-Do Branches: Glendowie Branches: Papakura | Waiau-Pa | Glendowie

Beginners' Course Registration

PLEASE COMPLETE THE FORM BELOW TO REGISTER

Please select name of class:
Details of those registering:

Name:

Address:
Age:
 Male Female
Date of Birth:
Occupation
 Student
Any medical conditions we should be aware of?:

YES No

If yes, please state:
 
Click here to add other Family Members
Name:
Address:
Age:
 Male Female
Date of Birth:
Occupation
 Student
Any medical conditions we should be aware of?:

YES No

If yes, please state:

Name:

Address:
Age:
 Male Female
Date of Birth:
Occupation
 Student
Any medical conditions we should be aware of?:

YES No

If yes, please state:
General Contact details:
email:
 
Home phone:
 
Work phone:
 
Mobile phone:
 
If under 18, name of parent / caregiver:

 

Do those registering have any previous Martial Arts experience?

YES No

 

If yes, please give brief details
How did you hear about us?

Word of mouth Website Newspaper Radio
Poster Demonstration Yellow Pages Television
Other

Any other information or questions

DECLARATION
I hereby agree to abide by the following conditions:

  • The instructor has the right to withhold tuition from me if I disturb the class in any way.
  • I hold myself responsible for any injury that I may sustain in the course of my training.
  • I agree not to misuse the knowledge gained through the classes.
  • There shall be no refund of my membership or training fees paid in advance.

PRIVACY ACT
I give my permission for the International Taekwon-Do Foundation Inc. to collect, store and use any information provided by me, as well
as any information collected about my progress or activities in Taekwon-Do, for its own purposes and business only. I understand that this information will not be disclosed to any other organisations without my prior consent. I recognise the right to view this information and make corrections where appropriate.

I have read and accept the above conditions.



 


     

Home | Taekwon-Do Branches | Merchandise | About Paul McPhail

Paul M Limited
142 Great South Road, PO Box 75-549, Manurewa, Auckland, New Zealand
Tel / txt 64-21-983 532