Registration Kids Contact Number Email Date 1. Is your child taking ,any form of medication (e.g. tablets, inhaler)? NOYES 2. Is your child prone to headaches, fainting or dizziness? NOYES 3. Is your child experience any chest pains, wheeziness or sickness during or after physical activity? NOYES 6. Is your child loose consciousness or loose his/her balance as a result of dizziness? NOYES 7. Are you aware, through your own experience or a doctor advice of any other reason why your child should seek medical approval before exercising? NOYES If there is any other condition which may affect participation which the instructors should be made aware of, please give details I undersigned, give my permission to Krav Maga eXplode to use for public viewing on Websites, posters, etc. pictures and/or videos taken during any Krav Maga eXplode training or event taped and used by the promoter and its agents, I waiver any compensation thereof I undersigned, give my permission to Krav Maga eXplode to use for public viewing on Websites, posters, etc. pictures and/or videos taken during any Krav Maga eXplode training or event taped and used by the promoter and its agents, I waiver any compensation thereof 4. Is your child has any bone or joint problem that could aggravated by physical activity? NOYES 5. Are you aware through your own experience or a doctor`s advice of any other reason why your child should not take part in physical activity without medical approval? NOYES If you are a new member where did you hear about us? Date of Birth Nationality Address Child First name Child Surname Parent Surename Parent First Name
