Student Membership Form

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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

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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**

PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student Membership Form

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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

Student Information

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

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

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Mobile Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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

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Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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

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Age {{ Cognito.resources["required-asterisk"] }} , { 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 }

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Have you ever been convicted of a violent criminal offence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Are you, or have you ever been on the National Sex Offenders List {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Health and Emergency Information

Health Declaration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Notes on Illness or Medication {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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

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

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Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Important – Read Carefully

Full terms and conditions 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 }

Signed Date {{ Cognito.resources["required-asterisk"] }} , { 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**

PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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The email has been sent.

Your progress has been saved.

Copy your form link:

Email me my link:

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Student Membership Form

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{binding BillingName}

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{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

Student Information

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

{binding displayValue}

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

{binding displayValue}

Mobile Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

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

{binding displayValue}

Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

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

{binding displayValue}

Age {{ Cognito.resources["required-asterisk"] }} , { 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 displayValue}

Have you ever been convicted of a violent criminal offence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are you, or have you ever been on the National Sex Offenders List {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Health and Emergency Information

Health Declaration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Notes on Illness or Medication {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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

{binding displayValue}

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

{binding displayValue}

Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Important – Read Carefully

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

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

Signed Date {{ Cognito.resources["required-asterisk"] }} , { 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**

PKA Club Membership, Uniform and Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Student Membership Form

Club Information

Student Information

Health and Emergency Information

Important – Read Carefully

Uniform

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Student Membership Form

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Club Information

Student Information

Health and Emergency Information

Important – Read Carefully

Uniform

Your progress has been saved.

Student Membership Form

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

Club Information

Student Information

Health and Emergency Information

Important – Read Carefully

Uniform