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Kane Academy Open day lesson booking form.
For all programmes running at the Kane Academy
HALF PRICE Uniform If you sign up on the day.
Come try the lesson for free and chat to one of the team.
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"Remember... You don't have to be the big guy!" Sifu Rebecca Kane
Which programme are you wishing to book onto?
*
Choose
Tiny Tigers ages 4-7 years
Ninja Kids ages 7-12 years
Teen and Adult Kickboxing
Ladies Kickboxing
Student Name
*
Your answer
Date of Birth
*
EG: 03/02/1993
Your answer
Mobile Number
*
Your answer
Email Address
*
Your answer
Address
*
Your answer
Postcode
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Number
*
Your answer
Medical Conditions
*
Do you suffer or have you suffered from any of the following?
No known medical conditions
Heart Disease?
Family Heart Disease?
Chest Complaints?
High Blood Pressure?
Fainting or Dizziness?
Circulatory / Blood Problems?
Epilepsey / Seizures / Fits?
Major Surgery?
Do you regularly take prescribed drugs?
Bone or joint conditions?
Lower Back Pain or Injury?
Has your doctor ever advised you against exercise due to injury / illness?
Are there any other medical conditions you feel we should know about?
Required
If you have selected any of the above, please provide further details.
Your answer
How Did You Hear About Us?
*
Google
Social Media
Linkedin
Netmums
Banner / Leaflet / Poster
Friend Refferal
School/Nursery
Other:
Required
Please tell us why you want to join.
*
Develop Confidence
Improve Fitness
Learn Self Defence
Socialise / Have Fun
Improve Discipline
Weight Management
New Skill / Challenge
Improve Balance / Coordination
Stress Management
Other:
Required
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