WOMEN'S SELF-DEFENCE 

Medical information:
Sign in to Google to save your progress. Learn more
It is important that we can keep you safe during our sessions. Please let us know if there is anything in your medical history that we should be aware of. Also, if anything changes during the 6 week course, please let us know as soon as possible.
*
Medication.
Please list any medication that you are currently taking:
*
Do you have a criminal record? *
If yes, please give a very basic description of your last offence, and the date that it occurred:
Emergency contact information:
Please provide the following in case of emergency:
Emergency contact name: *
Emergency contact phone number: *
Emergency contact relationship to you: *
Declaration:

By signing this form I state that the above information is true and correct. I will abide by the terms and conditions of Macmillan Martial Arts Academy, as explained by its instructors. I accept that, whilst all reasonable care is taken, my instructors are not legally responsible for any accidents or injuries that may occur whilst I am training in the classes. I also understand that I am expected to maintain a standard of behavior, both during training and in general, which will not bring Macmillan Martial Arts Academy into disrepute, knowing that failure to do so may result in expulsion. I am medically fit to undertake intensive physical training.

DECLARATION: “I promise to uphold the true spirit of Macmillan Martial Arts Academy and Martial Arts in general. I promise never to use the skills that I am taught against any person, except for the defence of myself, my family and friends in the instance of extreme danger or unprovoked attack, or in the support of law and order.”

Signed (please insert full name): *
Date: *
MM
/
DD
/
YYYY
Preferred name:
Email address: *
Home address and postcode *
How did you hear about us? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report