Student Membership Form

  1. { binding displayValue, mode=oneTime }

Welcome to our online membership application form.   The form should take no longer thatn 15minutes to complete.

Enter the exciting world of Sport Kickboxing with KickBoxUK

Club Information

{ binding firstError.message }
{ binding firstError.message }

Reception is 5:10 class (4-5 years)

Cadets is 5:45 class (6-9 years)

Juniors is 6:45 class (10-13 years)

Adults is 7:45 class (14+)

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Student Information

Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

We use email to send information about club events gradings and license expiry and also send training tips.

Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Photographs and videos are taken in classes and tournaments. Images are used for various promotional materials. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever been convicted of a violent criminal offence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Are you, or have you ever been on the National Sex Offenders List {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Health and Emergency Information

Health Declaration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Important – Read Carefully

 Full terms and conditions including cancellation policies are on our website at www.kickboxuk.com/terms-and-conditions. 

I accept and understand the practice of kickboxing and activities at this club is entirely at my own risk. I shall not hold responsible, KickboxUK Ltd, the Professional Kickboxing Association, its principal, its officials, the instructors or any of my fellow members, for any injury I may sustain. I have read and understand the terms of my membership including my obligations around keeping my PKA license up to date and cancellation of the standing order should I stop training, I also accept that only equipment ordered directly from my instructor or via KickboxUK.net can be worn within classes.  I understand that training fees and Memberships are non-refundable and non-transferable between individuals. All the information given on this form is true to the best of my knowledge.

As part of your membership membership package with the PKA you have your license (little red book) included for the first 12months.  This should be renewed in 12months time if you are continuing to train with the PKA.   Your signature is required below for our insurance purposes and to ensure you have read and understood the terms of membership detailed above. 

{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Uniform

**PLEASE NOTE IT IS CLUB POLICY THAT ONLY UNIFORM AND EQUIPMENT PURCHASED FROM YOUR KICKBOXUK COACH OR VIA WWW.KICKBOXUK.NET CAN BE WORN IN OUR CLASSES**

{ binding firstError.message }

How to work out Trouser Size: 

Measure height of Student in cm.  If student is 160cm tall they need 160 trousers.  120cm tall need 120 trousers 

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Would you like to add shin protectors to your order? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

RRP £12.50 - 20% off Shin/Foot Protectors

{ binding firstError.message }

length shown are shin lengths from bottom of knee to top of ankle. 

{ binding firstError.message }
{# pageNumbers}
{ binding firstError.message }

**This is the remaining weeks payment to take  you up to the end of the next month when your standing order / direct debit should begin.  

**Please discuss standing order value directly with your coach

{ binding firstError.message }

**This is the remaining weeks payment to take  you up to the end of the next month when your standing order / direct debit should begin.  

**Please discuss standing order value directly with your coach

{ binding firstError.message }

**This is the remaining weeks payment to take  you up to the end of the next month when your standing order / direct debit should begin.  

**Please discuss standing order value directly with your coach

{# pageNumbers}

{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{binding Name}:{binding displayValue}---
{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}
{# pageNumbers}

Student Membership Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{{ Cognito.resources['order-billing-info-header'] }}

{binding BillingName}
{binding BillingAddress.FullInternationalAddress}
{binding PhoneNumber}
{binding EmailAddress}
{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}

Welcome to our online membership application form.   The form should take no longer thatn 15minutes to complete.

Enter the exciting world of Sport Kickboxing with KickBoxUK

Club Information

Coach Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Membership type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Student Information

Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Photographs and videos are taken in classes and tournaments. Images are used for various promotional materials. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever been convicted of a violent criminal offence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you, or have you ever been on the National Sex Offenders List {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Health and Emergency Information

Health Declaration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Notes on Illness or Medication {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Relationship to Student {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Important – Read Carefully

 Full terms and conditions including cancellation policies are on our website at www.kickboxuk.com/terms-and-conditions. 

I accept and understand the practice of kickboxing and activities at this club is entirely at my own risk. I shall not hold responsible, KickboxUK Ltd, the Professional Kickboxing Association, its principal, its officials, the instructors or any of my fellow members, for any injury I may sustain. I have read and understand the terms of my membership including my obligations around keeping my PKA license up to date and cancellation of the standing order should I stop training, I also accept that only equipment ordered directly from my instructor or via KickboxUK.net can be worn within classes.  I understand that training fees and Memberships are non-refundable and non-transferable between individuals. All the information given on this form is true to the best of my knowledge.

As part of your membership membership package with the PKA you have your license (little red book) included for the first 12months.  This should be renewed in 12months time if you are continuing to train with the PKA.   Your signature is required below for our insurance purposes and to ensure you have read and understood the terms of membership detailed above. 

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Signed Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Uniform

**PLEASE NOTE IT IS CLUB POLICY THAT ONLY UNIFORM AND EQUIPMENT PURCHASED FROM YOUR KICKBOXUK COACH OR VIA WWW.KICKBOXUK.NET CAN BE WORN IN OUR CLASSES**

Trouser Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
T-Shirt Size (chest sizes) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Glove Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Colour {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Colour {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Would you like to add shin protectors to your order? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Shin Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Classes (weeks) remaining in month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Classes (weeks) remaining in month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Classes (weeks) remaining in month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
The email has been sent.

Your progress has been saved.

{ binding firstError.message }

Student Membership Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{{ Cognito.resources['order-billing-info-header'] }}

{binding BillingName}
{binding BillingAddress.FullInternationalAddress}
{binding PhoneNumber}
{binding EmailAddress}
{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}

Welcome to our online membership application form.   The form should take no longer thatn 15minutes to complete.

Enter the exciting world of Sport Kickboxing with KickBoxUK

Club Information

Coach Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Club Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Membership type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Student Information

Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Photographs and videos are taken in classes and tournaments. Images are used for various promotional materials. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever been convicted of a violent criminal offence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you, or have you ever been on the National Sex Offenders List {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Health and Emergency Information

Health Declaration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Notes on Illness or Medication {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Relationship to Student {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Important – Read Carefully

 Full terms and conditions including cancellation policies are on our website at www.kickboxuk.com/terms-and-conditions. 

I accept and understand the practice of kickboxing and activities at this club is entirely at my own risk. I shall not hold responsible, KickboxUK Ltd, the Professional Kickboxing Association, its principal, its officials, the instructors or any of my fellow members, for any injury I may sustain. I have read and understand the terms of my membership including my obligations around keeping my PKA license up to date and cancellation of the standing order should I stop training, I also accept that only equipment ordered directly from my instructor or via KickboxUK.net can be worn within classes.  I understand that training fees and Memberships are non-refundable and non-transferable between individuals. All the information given on this form is true to the best of my knowledge.

As part of your membership membership package with the PKA you have your license (little red book) included for the first 12months.  This should be renewed in 12months time if you are continuing to train with the PKA.   Your signature is required below for our insurance purposes and to ensure you have read and understood the terms of membership detailed above. 

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Signed Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Uniform

**PLEASE NOTE IT IS CLUB POLICY THAT ONLY UNIFORM AND EQUIPMENT PURCHASED FROM YOUR KICKBOXUK COACH OR VIA WWW.KICKBOXUK.NET CAN BE WORN IN OUR CLASSES**

Trouser Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
T-Shirt Size (chest sizes) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Glove Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Colour {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Boxing Glove Colour {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Would you like to add shin protectors to your order? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Shin Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Classes (weeks) remaining in month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Classes (weeks) remaining in month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Classes (weeks) remaining in month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }