Name *

First

Last

Age *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Email *

Confirm Email

Please note to use this email when booking future classes or making any payments with SKM.

Phone *

Medical History

Do you have a heart condition, high blood pressure or circulatory problems? *

Do you have diabetes? *

Do you suffer from epilepsy? *

Do you ever experience pain in your chest when exercising or at rest? *

Do you ever feel faint or suffer from dizzy spells? *

Do you have back pain or joint conditions that could be exacerbated by exercise? *

Do you have asthma? *

Have you had any surgery in the past year that may affect your physical activity? *

Are you aware of any other condition or injury that may give reason to modify your exercise programme? *

Are you taking any medication? *

Any medical details you wish to tell us about

If you have ticked yes to any of the above questions please give details

EMERGENCY CONTACT – NEXT OF KIN DETAILS (A CLOSE RELATIVE OR FRIEND)

Emergency Contact Name/ Parent Guardian *

First

Last

Emergency contact Number *

Terms & Conditions

Data Protection *

I Agree

Data Protection : I agree for SKM Tactical to hold my data, That I have provided to conduct administration in relation to its activities SKM Tactical may use my contact details to inform me of events or changes in relation to its activities. Your data will be held within password protected files on our servers and on third party software provider servers. We will not share or divulge any information you provide to us to any third party. Your information will only be used by SKM Registered Staff. We will delete your data held by us after Six months from your confirmed leaving date or course end date. Your record of payment will be kept and held on third party financial institutions servers as appropriate to our payment collection method. If you wish us to remove your data held sooner or have a complaint please email us via our contact page on our website.

Disclaimer *

I agree
I agree as Parent/Guardian

Disclaimer : I acknowledge that the activity, Close Combat Training I am to undertake is a relatively dangerous activity and that by participating in it I am exposed to certain risks. I acknowledge and understand that whilst participating in such activity: I may be injured; other person’s participation in such an activity may cause me injury or may damage my property. I may cause injury to other persons or damage their property. I assume the risk of and responsibility for any injury or property damage resulting in my participation in the activity. I acknowledge and understand that SKM Tactical recommends acquiring Personal Accident Insurance for sports participation or becoming a member of the International Close Combat Association which includes full insurance for its member{details of membership can be found on our web site). Signing as Parent or Guardian I acknowledge that the activity my child is to undertake is a relatively dangerous activity and that by allowing them to participate in it will expose them to certain risks. I acknowledge and understand that whilst participating in such activity: They may be injured; other person’s participation in such an activity may cause them injury or may damage their property. They may cause injury to other persons or damage their property. You assume the risk of and responsibility for any injury or property damage resulting in your Childs participation in the activity.

Signature *

Clear Signature

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SKM Registration Form

Before booking you in, we need to register you as a member.

Medical History

EMERGENCY CONTACT – NEXT OF KIN DETAILS (A CLOSE RELATIVE OR FRIEND)

Terms & Conditions

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