Register - Genki Judo

First Name *

Last Name *

Address *

Postcode

Home Telephone Number

Mobile Phone

Email Address *

Password *

Confirm Password *

Date of Birth

Sex

Male
Female

Parent/Guardian Details (for players under 16)

Name(s)

Address

Postcode

Home Telephone Number

Mobile Number

Email Address

Have you done Judo before?

Association: (eg: JS, BJA, WJA, NIJF):

Grade:

License Number:

Expiry Date:

Note for new players/parents: Genki Judo Club are affiliated to JudoScotland and the British Judo Association. A free provisional membership is required after four sessions, and a full paid membership after four months. Membership forms can be downloaded from www.judoscotland.com/membership

Medical Information:

Please detail any medical information we should be aware of, including any medication you require: (e.g. epilepsy, asthma, ADHD, diabetes, etc).

Do you consider yourself to have a disability?

If yes, what is the nature of your disability?

May we share your information with medical professionals if necessary for treatment following an accident/injury?

Emergency Contact:

Please insert the information below to indicate the person(s) who should be contacted in case of an incident/accident:

Contact name 1 (parent/guardian/other):

Emergency contact number:

Contact name 2 (parent/guardian/other):

Emergency contact number:

Declaration: (players aged 16 and over, or parent/guardian on behalf of player under 16)

I confirm that all of the above information is correct at the time of return, and I agree to Genki Judo Club processing and storing my data in accordance with the club’s Privacy Policy (available from Head Coaches Allan Berry and Fraser Scott) as long as it is relevant to do so. I understand it is my responsibility to inform the club of any changes to the information given.

Date:

Player

Guardian

Data Protection:

I agree to allow the use photographic/video material of me in a judo capacity (optional)

I agree to being contacted by the club for regular updates on events, club news and other important information (optional)

Email
Text
Whatsapp

CLUB MEMBERSHIP FORM

Parent/Guardian Details (for players under 16)

Medical Information:

Emergency Contact:

Declaration: (players aged 16 and over, or parent/guardian on behalf of player under 16)