Subscribe for 5 Session Kids Trial

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

Email *

Full Name (Parent/Guardian if under 18) *

Address *

City *

Post Code *

Contact Number (Mobile)

Childs First Name *

Childs Surname *

Childs Date of Birth *

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) *

Where did you hear about us? *

Price

Payment Method

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*