STUDENT NAME (Grading candidate) *

First Name

Last Name

STUDENTS Date of Birth *

MM

DD

YYYY

Parent or Guardian Name submitting this form *

First Name

Last Name

Parent / Guardian Mobile Number *

(###)

###

####

HEALTH DECLARATION *

Are you aware of any health problems that your child has that, in the interests of your safety, the academy/club should be advised of?

YES

NO

DECLARATION OF UNDERSTANDING *

1. I fully recognise and understand that participating in martial arts in general, and Kyokushin karate in particular, can be dangerous. 2. By clicking "SUBMIT", I hereby accept full responsibility for my child's safety and release the organizers of this grading, Kyokushin Karate North Bondi, from all and any liability to the maximum extent permitted by law for all and any injury, damage, cost (medical or other), or suffering as a result of my child's participation.

I understand