JKA Pre-Registration Form
All fields are REQUIRED.. Please provide valid information for better assistance.
Email address *
Class Selection *
Beginners class is a 6-months course for each term.
Required
Full Name *
Your answer
Mobile Phone *
Your answer
Place of Birth *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Nationality *
Please provide a copy of Identification or Passport at Dojo
Your answer
Current Kendo Grade *
Use "None" if necessary.
Your answer
Do You Have Special Medical Condition *
Disclaimer
I hereby certify that the information provided in this application is correct and truthful.

I also hereby declare that I am not member of any other similar Kendo organization in Indonesia that is not associated with Indonesia Kendo Association, Jakarta Kendo Association and/or Jakarta Kenyu-kai.

I agree to abide by the rules, regulations and requirements of the Jakarta Kendo Association and/or Jakarta Kenyu-kai.

Any activities contrary to and/or harmful to the reputation and activities of the club may result in suspended and/or immediate removal of my membership.

All above personal information will keep confidential by Jakarta Kendo Association and/or Jakarta Kenyu-kai (Jakarta Kendo Club) and solely for the purpose of club activities.

A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Jakarta Kendo Association. Report Abuse - Terms of Service - Additional Terms