Subscribe for Child Membership

Please enter information on the form below to process your membership to Cheshire Karate Academy

Email *

Address *

City *

Post Code *

Contact Number (Mobile)

Childs First Name *

Childs Surname *

Childs Date of Birth *

Gender *

Age *

Location *

Astbury Village Hall

Congleton High School

Sandbach School

Wesley Centre

Do you/your child(ren) have a medical condition? *

Medical Conditions Explained *

Is your child on any medication *

What Medication is your child using? *

Does Student Have Any Allergies *

Allergies *

Do we have permission to Give First Aid Treatment in the event of an emergency *

Do we have Permission To Travel With Student In The Ambulance in the event of an emergency *

In the event of an emergency where the child needs to be admitted do the hospital have permission to treat your child *

Do you give permission for photos to be taken of your child *

Do you give Permission to Place Photos taken by the club on our Website *

Do you give Permission to use Photos taken by the club on News Articles *

Do you give Permission to use Photos taken by the club on Social Media (Facebook, Google, Twitter, Instagram) *

First Parent Name *

First Parent Contact Number *

First Parent Relation To student *

Does the parent named above have legal responsibility over the above named children *

Second Parent Name

Second Parent Contact Number

Second Parent Relation to Student

Does the parent named above have legal responsibility over the above named children

Do we have your permission to add you to our clubs WhatsApp Group *

Where did you hear about us? *

Price

Payment Method

Bank Transfer/Direct Debit

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*