Manchester Maccabi Krav Maga Registration
First Name *
Enter your first name
Your answer
Last Name *
Enter your last name
Your answer
Your 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
Your address
Your answer
Your passport number and the name of the country who issued it
for example: 1234567 UK
Your answer
What's your age group? *
If you're under 16, please provide a Parent or Guardian's name.
Your answer
List any injuries, illnesses or allergies
We need to understand if a condition could affect your ability to train
Your answer
List any medication being taken
Your answer
Your doctor's name and phone number
Your answer
IMPORTANT: Please include the names and e-mail addresses of 2 references *
1) They need to able to vouch for you to learn Krav Maga and use it in self defence only. 2) They must NOT be direct family members.
Your answer
How did you hear about Krav Maga at Manchester Maccabi? *
I confirm all the above information is accurate and true. *
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