Name of person bookingThis applies if you are booking for a friend or your childName of person attending trial classThe name of your child if you're booking on their behalfEmail Address *PhoneDate of birth *Have you ever been diagnosed with any of the following: *Back InjuryNeck InjuryKnee/Leg/Foot InjuryHip/Shoulder InjuryHerniaHeart ConditionHigh Blood PressureAsthmaBronchitisArthritisSickle Cell Disease/AnemiaNONE of the aboveAre you currently showing symptoms of: *A Cold or FluHigh TemperatureDry CoughAches or Pains in the LimbsNONE of the aboveHave you had a positive Covid-19 test result in the past 4 weeks? *YesNoAre you currently on any medication? *YesNoWhich medication are you currently taking?Consent *I declare that I have answered all of the above questions accurately, I am / my child is fit and able to undertake Krav Maga/Kickboxing training and that it is my responsibility to make the instructors aware of any medication condition / ailment / and medication that is current. I also agree for my name and email address to be passed to the governing body, Krav Maga Global (UK) so they can send me my insurance information.SUBMIT HEALTH FORM
