Student Forms Please familiarise yourself with the website menu links and read the information available on the following pages to get a good understanding of our club before filling out this form; Assumption of Risk Notice FAQ Club Charter Club Rules Club Principles Club Grades Our Safeguarding Policy It is also strongly advised to read through the rest of the policies on our ‘LEGAL’ menu at the top before beginning your training with us. IF YOU ARE UNDER 18, A PARENT WILL HAVE TO FILL THIS FORM OUT ON YOUR BEHALF AND READ OUR PARENTAL STANDARDS POLICY – BASIC INFORMATION Full Name Preferred method of contact Email Facebook Messenger Whatsapp Please Join our Facebook group: https://www.facebook.com/groups/CloseCombatMA (opens in a new tab) We sometimes take a group photo at the end of lessons for the website, record footage for promotional videos and take photos and videos at gradings and competitions, it is absolutely fine to not want to be included if you don’t want yourself or your child to do so. If you are filling this out for yourself or a student under the age of 18, please tick all the boxes that apply I give consent for my child to be in club photos to be shared within the student only facebook group I give consent for my child to be in club photos to be shared for public advertising purposes I give consent for my child to be in club videos to be used as a learning aid for other students I am over 18 and I give consent to be in club photos to be shared within the student only facebook group I am over 18 and I give consent to be in club photos to be shared for public advertising purposes I am over 18 and I give consent to be in club videos to be used as a learning aid for other students What training sessions would you be available for Tue 6:30pm – 8:30pm Thu 6:30pm – 8:30pm Frid 6:30pm – 8:30pm Sat 11am – 1pm Date of Birth Mobile Number Home Number Email Do you want to subscribe to email updates? Yes No Height Weight (optional) Gender Male Female Other When you pay the CCMA annual membership fee for the first time you will receive a White Grade T-shirt. We need to know your size in advance to make sure we have your T-Shirt type and size in stock and ready to give you upon joining. Please check the size guide and T-Shirt images below and tick the correct boxes for your chosen T-Shirt type and size: T-Shirt Type: Unisex Short Sleeve Unisex Long Sleeve Ladyfit Youth Unisex Size: (Please pick a size for your type of T-shirt) Small Youth (SY) Medium Youth (MY) Large Youth (LY) Extra Small (XS) Small (S) Medium (M) Large (L) Extra Large (XL) Double Extra Large (XXL) Triple Extra Large (3XL) Hand Circumference: S: 15cm – 17cm M: 18cm – 20cm L: 21cm – 23cm XL: 24cm – 25cm EMERGENCY CONTACT INFORMATION Emergency Contact Name Who is this person to you? Emergency Contact Number Secondary Emergency Contact Number MEDICAL HISTORY History of heart problems? (Chest Pains, heart murmur or stroke) Yes No Diabetes? Yes No Asthma, breathing or lung problems? Yes No Allergies? Yes No Cancer? Yes No Seizures, seizure medication, neurological problems or dizziness? Yes No High blood pressure? Yes No Recent surgery? (past 12 months) Yes No Hernia or any condition that may be aggravated by exercise? Yes No Previously received advice about exercise? Yes No History of high cholesterol? Yes No Family history of coronary heart disease? Yes No Do you smoke tobacco products? Yes No Do you consume excessive alcohol? Yes No Do you take supplements of any kind? Yes No Are you on any medication? Yes No Back problems, joint or muscle disorder still affecting you? Yes No Do you have any skeletal injuries? Yes No Excessive stress, depression anxiety or sleep disorder? Yes No If you answered yes to any of the above, please consult your doctor by phone or in person before you start your martial arts training. Tell your doctor about this medical questionnaire, which questions you answered yes to and get advice about how to moderate your exercise during training. Please provide us with details of any of the above issues and any advice you've been given so that we can accommodate your needs If you are filling this form in for anyone under the age of 18, do you give parental consent to carry out emergency first aid and/or other necessary medical treatment if the need arises? I give parental consent for emergency first aid and/or other medical treatment if the need arises I DO NOT give parental consent (This will prevent your child from training) I am filling this form out for myself and I am over 18 FITNESS LEVEL AND GOALS What are your fitness concerns or goals? Weight loss Strength Power Endurance Cardio fitness Flexibility Agility Balance How long has it been since you have exercised regularly? Do you participate in any other sports or physical training regularly? Do you have any martial arts or self-defence experience? STATEMENT OF TRUTH I have truthfully filled out the personal information, medical history and fitness level and goals forms to the best of my knowledge at this current time. Yes I understand CCMA is covered with public liability insurance and I will get student insurance, I will take every precaution necessary to maintain my own health and safety, taking advice from my doctor and instructor seriously. Yes I understand that I have to follow instructions carefully, exercise control whilst learning at a steady pace for my own and my training partner's skill level and take care not to cause harm to other students. Yes I confirm that I understand in full that any activity in which I participate will carry inherent risks associated with any practice or competition within combat arts, martial arts or self-defence. Furthermore, I understand that the risk of serious injury is present and I will follow all safety rules and regulations in place to help protect me and my fellow students during training. Yes I have read the Assumption of Risk notice listed in the Students Menu on this website and I wish to participate in lessons, training sessions, gradings, and possibly competitions, provided by Close Combat Martial Arts and any registered instructors, coaches, or staff. Yes I confirm that I have familiarised myself with the FAQ page, Club Charter, Club Rules, Club Principles, Club Grades and Our Safeguarding Policy. and I have consulted with my Instructor if I don't understand any of the information provided. Yes I confirm that I understand the nature of the activity in which I am about to participate, and appreciate that any practice of combat, self-defence or martial art usually includes a degree of martial arts-based fitness training. With this in mind, I can agree that I am fit to participate and agree to assume all risks associated with the above, hereby withdrawing any liability from the named club, instructors, association, or other relevant parties. Yes I understand that if I fail to inform my instructor of any health issues that may later cause me problems, or fail to follow advice from my doctor, I am fully liable for the consequences. Yes Should I be unclear on any risks involved, or not feel comfortable releasing the above-named from all positions of liability, I will not sign this document. Please take my signature as my acceptance and assumption of all risks involved, as described to me by my instructor and stated within this document. Yes I fully understand the above statements and WILL NOT sign below if I don't. I have ticked each statement box as if they are true. Please type your full name as a digital signature. Send Δ