Manchester Maccabi Krav Maga Registration
First Name
Enter your first name
Your answer
Last Name
Enter your last name
Your answer
e-mail address
We'll use the e-mail address to keep you informed. If you don't have an e-mail address we'll need a phone number (see next question)
Your answer
Your phone number
We may need to call you to keep you informed
Your answer
An emergency phone number
We may need to call someone else in the event of an emergency involving you.
Your answer
Are you male or female?
Required
What's your age group?
If you're under 16, please provide a Parent or Guardian's name.
Your answer
If you're under 16, Please tick the box to show your parent/guardian agrees you can go on the course
List any injuries, illnesses or allergies
Your answer
List any medication being taken
Your answer
Your doctor's name and phone number
Your answer
Please include the names and addresses of 2 references, who can vouch for you to learn Krav Maga and use it in self defence only.
Your answer
How did you hear about Krav Maga at Manchester Maccabi?
I confirm all the above information is accurate and true.
Required
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