Style* 


Age* 


First Name* 

Surname* 

Place of Training* 

Name of school or venue where your class is held
Town* 

Date of First Class Attending* 

Medical Information
Has the person attending the class undergone
any surgery within the last 6 months?  


If ‘YES’ please add details in the box below
Has the person attending the class ever been
diagnosed with any form of heart problem?  


If ‘YES’ please add details in the box below
Does the person attending the class have
any disabilities that are relevant for training?  


If ‘YES’ please add details in the box below
Is the person attending the class currently
taking any medication?  


If ‘YES’ please add details in the box below
Does the person attending the class
suffer from high blood pressure?  


If ‘YES’ please add details in the box below
Does the person attending the class
suffer from asthma?  


If ‘YES’ please add details in the box below
Your Comments 

Contact Info
Your contact details are solely for our
use only and will never be shared with
any third parties. They will only be used
in the event of an emergency or to contact
you with important information regarding
your class. Your email address will only be
used by us to be added to our SAMA email
newsletter to keep you updated with the
latest news and offers. If you would like to
view our full GDPR privacy policy
please click here
Contact Tel No.* 

Contact Tel No. 2  

Email Address 

Declaration
The person attending the class has never
been convicted of any charge involving
physical violence. They promise not to use any
of the skills taught outside of the class
except in practice, self defence or for law
and order. They will not use their training
to provoke an attack and promise to uphold
the true spirit of the martial arts.
Please Note
SAMA Organisation is a private members
club. SAMA Organisation has the right to
terminate any membership if club rules
are not upheld. SAMA organisation has the
right to refuse membership and further
training if we believe this is in the best
interests of the student and/or the class.
Whilst SAMA will do their best to
accommodate individual needs, our
instructors >may refuse membership on the
grounds of safety to other students
and staff. Students with disabilities
or health conditions are advised to contact
us prior to attending to ensure suitability
of karate or kickboxing training. All
information on this form is held in
confidence by the SAMA Organisation.
 

*