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Kyudokan Goju Ryu Karate Do

Kyudokids Membership Form

Our Kyudokids all-in Membership includes weekly access to your chosen dojo location, the Kyudokan App training videos, insurance, grading fees + belt and even a free karate uniform when you join.

Please complete the form below and click submit, will then process your application and confirm your membership via email. We look forward to welcoming you to the Kyudokids.

Completion of this membership form is required for all new applicants.

Kyudokids Membership Application

Membership Type
I am applying for a*
- Single Membership at £30 per month
- Double Membership at £60 per month
- Triple Membership at £90 per month
Please indicate the Dojo you will be attending*
- Tuesday - Places Leisure Centre Eastleigh
Member's Information
Name*
First Last
Pronoun*
Date of Birth*
DD slash MM slash YYYY
Height of Student*
Name*
First Last
Pronoun*
Date of Birth*
DD slash MM slash YYYY
Height of Student*
Name*
First Last
Pronoun*
Date of Birth*
DD slash MM slash YYYY
Height of Student*
Parent / Guardian
Prefix First Last
Optional 2nd Parent / Guardian
Prefix First Last
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Email Address*
Enter Email Confirm Email
Alternative Email Address
Optional
Enter Email Confirm Email
Contact Number*
Alternative Number
Medical and Emergency Contact
Medical Conditions*
Do you have any medical conditions or allergies we should be aware of:
- No
- Yes
About Your Medical Condition(s)*
Emergency Contact Name
First Last
Emergency Contact Number
Payment
Payment*
Securely pay for your subscription via credit or debit card.
You hereby authorise Kyudokan to set up a continuous monthly payment on the card entered below for the selected fees pertaining to this membership.

Card Details

Cardholder Name
Monthly membership*
- I understand that cancelling the membership is subject to a 1 month notice period.
Declaration*
- I am aware and accept that the practice of martial arts involves the risk of injury and that I agree to abide by the association rules.
Photograph / Video Consent*
Please can you confirm your approval below for club photos to be taken during events, which may be used on our website, social media, or for promotional literature:
- Yes I am happy for this
- No please do not include me in this
Comments
This field is for validation purposes and should be left unchanged.

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