Student Annual Membership/Insurance and Application Form

Full Name (required)

Your Email (required)

Full Address (required)

Date of Birth :

Occupation :

Tel Home :

Mobile :

Pre Exercise Medical Questionaire:

Please answer Yes or No to the Following Questions

Have your Doctor ever said you have heart disease or any other cardiovascular problem?

 yes no

Is there a history of heart disease in your family?

 yes no

Has your doctor ever said you have high blood pressure?

 yes no

Do you ever have pains in your heart and chest after undergoing minimal exertion?

 yes no

Do you often get headaches feel faint or dizzy?

 yes no

Do you suffer from pain or limited movement in any joints or bones which have
ever been aggravated by exercise or might be worse by it?

 yes no

Are you taking drugs medication or recuperating from a recent illness or operation at the moment?

 yes no

Do you have any other condition that might affect your ability to practice Sun Kune Do
alleged activities?

 yes no

Are you 35 or over and unaccustomed to physical exercise?

 yes no

If you have answered YES to one or more of the above questions consult your doctor and a medical note of approval is required before starting your training.
If you have answered NO to all of the above questions you should feel assured that you are ready to begin.

When last did you have a medical?

Personal:

Have you ever been convicted of a crime?

 yes no

If YES may we ask to provide and or enquire or taking a police check to the nature of the crime?

 yes no

(The International Sun Kune Do Organisation reserves the right to refuse an applicant)

Have you practised Martial Arts before?

 yes no

If Yes please give details including duration and grade obtained?

______________________________________________________________________________________________
Are you the person named on this form?

 yes no

Note:
Annual Insurance/Membership. Senior (16 years and over £60 includes uniform) Junior (14 and 15 £40 includes uniform)
Please provide two passport size photos to accompany this form. All checks should be made payable to the British Sun Kune Do Organisation.
DECLARATION

Your Comments (optional)

I (full name) have read, answered and fully understood all the questions and wish to apply for membership of the International Sun Kune Do Organisation. I hereby agree to abide by the constitution and the by-laws of the International Sun Kune Do Organisation. I am fully aware that the practice of Sun Kune Do alleged activities is entirely at my own risk. I shall not hold responsible the Club, other club members, its principle officers, or instructors for any injury that I may sustain. I understand that membership is non transferable and that all monies paid are non refundable.

Please tick box if you are ready to register