Membership-1 Membership Application Membership Type*Single AdultFamily How many children?*1234 Name*FirstLast Phone* Email* Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Gender*MaleFemaleIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Medical HistoryJujutsu (self-defence) Class Single Senior Jujutsu (self-defence) ClassTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Single Iaido (Japanese sword) ClassThursday 7:00pm-8:30pmJodo (traditional stick) Class Single Jodo (traditional stick) ClassMonday 7:00pm-8:30pm Father's NameFirstLast Father's Phone Father's Email Is father attending class?*YesNo Father's Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901yearIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Father's medical historyJujutsu (self-defence) Class Father Senior Jujutsu ClassTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Father Iaido ClassThursday 7:00pm-8:30pmJodo (traditional stick) Class Father Jodo ClassMonday 7:00pm-8:30pm Mother's NameFirstLast Mother's Phone Mother's Email Is mother attending class?*YesNo Mother's Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901yearIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Mother's medical historyJujutsu (self-defence) Class Mother Jujutsu ClassTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Mother Iaido ClassThursday 7:00pm-8:30pmJodo (traditional stick) Class Mother Jodo ClassMonday 7:00pm-8:30pm Child 1 Name*FirstLast Child 1 Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Child 1 Gender*MaleFemaleIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Child 1 medical historyNo classes available for children under 6 yearsJudo Class Child 1 JudoTuesday 4:45pm-5:30pmThursday 4:45pm-5:30pmSunday 9:30am-10:15amJujutsu (self-defence) Class Child 1 Jujutsu intTuesday 5:45pm-6:45pmWednesday (Advanced) 5:45pm-6:45pmThursday 5:45pm-6:45pmSunday 10:30am-11:30am Child 1 Jujutsu SnrTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Child 1 IaidoThursday 7:00pm-8:30pmJodo (traditional stick) Class Child 1 JodoMonday 7:00pm-8:30pm Child 2 Name*FirstLast Child 2 Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Child 2 Gender*MaleFemaleIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Child 2 medical historyNo classes available for children under 6 yearsJudo Class Child 2 JudoTuesday 4:45pm-5:30pmThursday 4:45pm-5:30pmSunday 9:30am-10:15amJujutsu (self-defence) Class Child 2 Jujutsu intTuesday 5:45pm-6:45pmWednesday (Advanced) 5:45pm-6:45pmThursday 5:45pm-6:45pm Sunday 10:30am-11:30am Child 2 Jujutsu SnrTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Child 2 IaidoThursday 7:00pm-8:30pmJodo (traditional stick) Class Child 2 JodoMonday 7:00pm-8:30pm Child 3 Name*FirstLast Child 3 Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Child 3 Gender*MaleFemaleIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Child 3 medical historyNo classes available for children under 6 yearsJudo Class Child 3 JudoTuesday 4:45pm-5:30pmThursday 4:45pm-5:30pmSunday 9:30am-10:15amJujutsu (self-defence) Class Child 3 Jujutsu intJujutsu Tuesday 5:45pmJujutsu Wednesday (Advanced) 5:45pmJujutsu Thursday 5:45pmJujutsu Sunday 10:30am Child 3 Jujutsu SnrTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Child 3 IaidoThursday 7:00pm-8:30pmJodo (traditional stick) Class Child 3 JodoMonday 7:00pm-8:30pm Child 4 Name*FirstLast Child 4 Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Child 4 Gender*MaleFemaleIllness / Injuries / Other Relevant Information(Any previous or current illnesses, injuries, ailments (for example, asthma), inherent dispositions, operations, medical procedures or sporting injuries that may affect performance or ought to be considered): Child 4 medical historyNo classes available for children under 6 yearsJudo Class Child 4 JudoTuesday 4:45pm-5:30pmThursday 4:45pm-5:30pmSunday 9:30am-10:15amJujutsu (self-defence) Class Child 4 Jujutsu intTuesday 5:45pm-6:45pmWednesday (Advanced) 5:45pm-6:45pmThursday 5:45pm-6:45pmSunday 10:30am-1:15pm Child 4 Jujutsu SnrTuesday 7:00pm-8:30pmWednesday (Advanced) 7:00pm-8:30pmThursday 7:00pm-8:30pmSunday 11:45am-1:15pmIaido (Japanese sword) Class Child 4 IaidoThursday 7:00pm-8:30pmJodo (traditional stick) Class Child 4 JodoMonday 7:00pm-8:30pm Address* Street Address City Post Code Emergency Contact*ParentOther Emergency Contact Name*FirstLast RelationshipSelect valueSpouse/PartnerGrandmotherGrandfatherAuntUncleBrotherSisterFriend Emergency Phone* Name of person submitting form*FirstLast Submitter's Email*SubmitReset
