Member Information

Please complete your personal details below

First Name *

Last Name *

Address 1 *

Address 2

Postal Code *

Home Telephone No: *

Mobile Tel ( Parents mobile if under 18): *

Email Address: *

Name of Emergency Contact: *

Telephone no: of emergency contact *

Further emergency contact details *

Telephone Contact Number/s of Emergency Contact *

Occupation or School Attended: *

Date or Birth: *

Please give details of any Judo or other martial art experience. *

Medical Information: Please provide details of any medical condition that we should be aware of . ie) recent accidents/ broken bones, epilepsy , asthma , diabetes etc . If you/ your child suffers from asthma please provide a clearly labeled inhaler which can be stored in the club first aid box.

I have read and agree to the code of conduct of Japan Arts Centre and to comply with insurance regulations by holding current membership of the British Judo Association *

Yes