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.
We can't wait to help you!
Sign in to Google
to save your progress.
* Indicates required question
"Remember... You don't have to be the big guy!" Sifu Rebecca Kane
Which programme are you wishing to book onto?
Tiny Tigers ages 4-7 years
Ninja Kids ages 7-12 years
Teen and Adult Kickboxing
Date of Birth
Emergency Contact Name
Emergency Contact Number
Do you suffer or have you suffered from any of the following?
No known medical conditions
Family Heart Disease?
High Blood Pressure?
Fainting or Dizziness?
Circulatory / Blood Problems?
Epilepsey / Seizures / Fits?
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?
If you have selected any of the above, please provide further details.
How Did You Hear About Us?
Banner / Leaflet / Poster
Please tell us why you want to join.
Learn Self Defence
Socialise / Have Fun
New Skill / Challenge
Improve Balance / Coordination
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service