Ni Bonchi Judo Club Inc

Registration Form

Member Details:

First name

Last name

Date of Birth

Day

Month

Year

Phone

For children under the age of 18, this can be the parent/carer's phone number

Email

For children under the age of 18, this can be the parent/carer's phone number

Address

Gender

Female

Male

Other

Do you identify as Aboriginal or Torres Strait Islander

Yes

No

Parent/Carer (or Emergency Contact) Details:

If the joining member is under the age of 18, this section should be parent/carer details. For members over the age of 18 please provide emergency contact details

Parent/Carer (or Emergency Contact) First Name

Parent/Carer (or Emergency Contact) Surname

Parent/Carer (or Emergency Contact) Mobile

Parent/Carer (or Emergency Contact) Email

Medical and Other Information:

Do you have any medical conditions or disabilities that we should be aware of for safety reasons? Please specify below:

Do you have any allergies?

Yes

No

If yes, please specify below:

Enrolment Information:

Please select your class

Kinder Judo (5:00pm - 5:45pm Monday)

Junior Judo (6:00pm - 7:00pm Monday and Thursday)

Senior Judo (6:00pm - 8:00pm Monday and Thursday)

Please specify your clothing size

Have you participated in Judo in the past? If so, please state your belt level

Do you consent to being photographed and for those photos to be used for club promotion and social media?

Yes

No

How did you hear about Ni Bonchi?

I understand that Judo is a physical activity and accept the risk associated with this. I will follow dojo rules and expectations and will support a positive, respectful dojo environment.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.