Empowered Martial Arts – Trial Registration Form Please enable JavaScript in your browser to complete this form.Child's name *FirstLastDate of birth *Age *Gender *MaleFemalePreferred trial class days (we offer a free week of trial classes and recommend attendance of at least 2) *TuesdayWednesdayThursdayFridayHow did you hear about us?Social Media (Facebook/Instagram)Google SearchFamily/FriendsFlyers/Posters/VanSchool NewsletterOtherHas your child ever been restricted or denied from participating in physical activity, sport or martial arts for any reason? *YesNoDoes your child have any on-going medical conditions? *Yes (please specify below)NoDetails of on-going medical condition:Has your child ever had an injury to a bone, muscle, ligament or tendon that has caused him/her to not participate in physical activity, sport or martial arts? *Yes (please specify below)NoInjury type and current condition/restrictions, we need to be aware of:Has your child ever felt faint or had spells of dizziness during physical activity/exercise that causes him/her to lose balance? *YesNoDoes your child have any muscle, bone or joint pain or soreness that is made worse by particular types of activity? *YesNoIs there any other medical or physical conditions/limitations that we should be made aware of before your child participates in our martial arts classes? (write 'None' if none) *Some medical conditions may require the provision of a medical clearance prior to training. I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. By ticking the box, I hereby agree to all terms and conditions as mentioned and release Empowered Martial Arts and all instructors and representatives from any liability, for personal injury which may occur to my child during his/her participation in classes. *I agree to the Terms and Conditions above.Today's date: *Parent's name *FirstLastMobile number *Email *Submit37027
