Little Dragon Application form

For Children 5 to 9 years – If you have family members training in older classes you can enter all members on that Application form

(Parents: Come along and train, get fit and learn the skills to help you and your child !)

Teaching team:
Sifu David Nicholls MSc (Sports & Exercise Science) 6th Degree Black Belt
Sifu  & CPO  Nic Cumming 3rd  Degree Black Belt (Child Protection Officer)
Sifu Adam Hawkins  1st Degree Black Belt
Graham Hawkins  1st Grade Brown Belt
Wales:
Sifu Matt Bithel 1st Degree Black Belt
Jo Hinchliffe Orange Brown Belt

Please complete the below form to register your child / children and set up online monthly payments based on details given in class
This price and membership cover is based on continuous payment  (classes run all year, excluding closure for 2 weeks Christmas holidays, and during competitions – which children can enter).

Children's class Application

(Parents/ Guardians please add YOUR details and then add the child / childrens details as required)

Please Choose which Class *

Watford Little Dragons 5-7 years

Bethesda Little Dragons (5-9 years)

Watford Little Dragons 8-9 years

Title Mr Miss Ms Mrs Dr

Parent's First Name *

Parent's Surname *

1st line home address *

2nd line home address

Town *

Post/Zip Code *

Contact phone No. *

Email address (this will be your online user name) *

Enter a password

Emergency Contact Person

Their Name / Relationship to child (E.g. Mother, Father, Uncle)

EMERGENCY CONTACT NUMBER *

Child/children Details (if brothers & sisters are training)

1st Child First Name *

1st Child Surname *

1st Child DOB *

dd/mm/yyyy

1st Child gender *

male

female

Add a 2nd Child? *

Yes

No

2nd Child First Name *

2nd Child Surname *

2nd Child DOB *

dd/mm/yyyy

2nd Child gender *

male

female

Add a 3rd Child? *

Yes

No

3rd Child First Name *

3rd Child Surname *

3rd Child DOB *

dd/mm/yyyy

3rd Child gender *

male

female

Add a 4th Child?

Yes

No

4th Child First Name *

4th Child Surname *

4th Child DOB *

dd/mm/yyyy

4th Child gender *

male

female

Name of instructor/friend/family who introduced you..

Training and Membership Options

How did you hear about this class? * Google Online advert Facebook Twitter Leaflet Banner outside venue Leaflet/poster at class venue Local shop advert/Leaflet Friend Friend SSK member training Family SSK member training Other

Help us understand your Goals

Improve Self confidence

Improve Co-ordination/balance

Improve Self Discipline

Improve Fitness / Posture

Improve Flexibility / strength

Anti bullying

Family Activity (dad/mum, sibling training)

Make new Friends in area

Medical reasons (outline details + contact instructor)

Other (please state what)Other (please state what)

Notes / Comment (120 characters maximum)

All information held in confidence by SSK. Occasionally our instructors take photographs during classes for our website, social media pages (eg Facebook) or posters. Please tick this box if you/your child does not wish to appear in these photographs. (Children’s full names are not included with photographs, unless they won an award – we would contact you, if that occurs)

I DO NOT want my / my child(ren)s photographs used

3 + Three = ? *

Please answer and help us stop SPAM

If you are human, leave this field blank.

*On 1 December 2012 the work of the Criminal Records
Bureau (CRB) was merged with the Independent Safeguarding Authority (ISA) to form the Disclosure and Barring Service (DBS).
From 1 December ‘CRB checks’ will be known as ‘DBS checks’.