MUSKC Membership Application & Medical Declaration

In order for you to participate safely in the activities we have planned, we require the following questionnaire to be completed in full.
Any changes in your medical or physical condition from the time of completing this form will require you to inform the club officials and complete a new form. We understand this information is sensitive, so just fill in as much as you are comfortable providing.

    Student Information

    This is a required question
    This is a required question
    Please enter a valid email address
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    Must be a number
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    Must be a number
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    Must be a valid email address
    This is a required question
    This is a required question

    Karate License Information

    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Medical Information

    Any medical information taken on this form will be treated securely and confidentially. We understand this information is sensitive, so just fill in as much as you are comfortable providing. This information will help provide understanding of any conditions that may inhibit your training, so that we can make provisions for helping you overcome any problems or issues so that you continue to progress and improve to the best of your ability.
    This is a required question
    This is a required question
    Please select "Yes" or "No".
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    Please select "Yes" or "No".
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    Please select "Yes" or "No".
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    Please select "Yes" or "No".
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    Please select "Yes" or "No".
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    Please select "Yes" or "No".
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    Consent Information

    Please select one options only.
    This is a required question
    Please select "Yes" or "No".
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    This is a required question
    Please select "Yes" or "No".
    This is a required question
    This is a required question