Craigieburn Martial Arts Centre

Applicants must be 18 years or older to complete this form. Please complete the “Family” membership form

Illness / 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):

Jujutsu (self-defence) Class

Iaido (Japanese sword) Class

Jodo (traditional stick) Class

Father's Information

Jujutsu (self-defence) Class

Iaido (Japanese sword) Class

Jodo (traditional stick) Class

Mother's Information

Illness / 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):

Jujutsu (self-defence) Class

Iaido (Japanese sword) Class

Jodo (traditional stick) Class

Child 1 Information

Illness / 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):

No classes available for children under 6 years

Child 2 Information

Illness / 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):

No classes available for children under 6 years

Child 3 Information

Illness / 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):

No classes available for children under 6 years

Child 4 Information

Illness / 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):

No classes available for children under 6 years

Emergency Contact Information

*** WARNING ***
Missing contact numbers for Father and Mother

*** WARNING ***
Missing contact number for Mother

*** WARNING ***
Missing contact number for Father

Name of person submitting form

*** WARNING ***
Missing Father's email

Please enter the Father's email above. Otherwise you will NOT receive a confirmation email. However, the membership application will be submitted 

*** WARNING ***
Missing Mother's email

Please enter the Mother's email above. Otherwise you will NOT receive a confirmation email. However, the membership application will be submitted