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 Close Combat Martial Arts before filling out this form; Assumption of Risk Notice, FAQ, Club Charter, Club Rules, Club Principles, Club Grades, Our Safeguarding Policy.

IF YOU ARE UNDER 18 A PARENT WILL HAVE TO FILL THIS FORM OUT ON YOUR BEHALF

BASIC INFORMATION

Full Name(required)

Do you use Facebook? Yes

Please Join our Facebook waiting list group: https://www.facebook.com/groups/ccmaclub (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 one of the following boxes(required) I give consent for my child to be in club photos and videos

I DO NOT give consent for my child to be in club photos and videos

I am over 18 and I want to be in club photos and videos

I am over 18 and I DO NOT want to be in club photos and videos

What training sessions would you be available for(required) Tue 6:30pm – 8:30pm (Age 14+)

Wed 6:30pm – 8:30pm (Age 14+)

Thu 6:30pm – 8:30pm (Age 14+)

Frid 6:30pm – 8:30pm (Age 14+)

Sat 11am – 1pm (Age 10 – 16)

Date of Birth(required)

Mobile Number(required)

Home Number

Email(required)

Do you want to subscribe to email updates? Yes

Height(required)

Weight (optional)

Gender Male

Female

Other

When you pay the CCMA Anual membership fee for the first time you will receive a White Grade Tshirt. 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:(required) Unisex Short Sleeve

Unisex Long Sleeve

Ladyfit

Youth Unisex

Hand Circumference:(required) S: 15cm – 17cm

M: 18cm – 20cm

L: 21cm – 23cm

XL: 24cm – 25cm

EMERGENCY CONTACT INFORMATION

Emergency Contact Name(required)

Who is this person to you?(required)

Emergency Contact Number(required)

Secondary Emergency Contact Number

MEDICAL HISTORY

History of heart problems? (Chest Pains, heart murmur or stroke)(required) Yes

Diabetes?(required) Yes

Asthma, breathing or lung problems?(required) Yes

Allergies?(required) Yes

Cancer?(required) Yes

Seizures, seizure medication, neurological problems or dizziness?(required) Yes

High blood pressure?(required) Yes

Recent surgery? (past 12 months)(required) Yes

Hernia or any condition that may be aggravated by exercise?(required) Yes

Previously received advice about exercise?(required) Yes

History of high cholesterol?(required) Yes

Family history of coronary heart disease?(required) Yes

Do you smoke tobacco products?(required) Yes

Do you consume excessive alcohol?(required) Yes

Do you take supplements of any kind?(required) Yes

Are you on any medication?(required) Yes

Back problems, joint or muscle disorder still affecting you?(required) Yes

Do you have any skeletal injuries?(required) Yes

Excessive stress, depression anxiety or sleep disorder?(required) Yes

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 too 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? (required) 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

How long has it been since you have exercised regularly?(required)

Do you participate in any other sports or physical training regularly?(required)

Do you have any martial arts or self-defence experience?(required)

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.(required) 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.(required) 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.(required) 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 have been briefed on the relevant safety rules and regulations in place to help protect me and my fellow students during training.(required) 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.(required) 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. (required) 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.(required) 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, that I am fully liable for the consequences.(required) 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.(required) Yes

I fully understand the above statements and WILL NOT sign below if I don't. I have ticked each statement box as they are true. Please type your full name as a digital signature.(required)