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First Name *

Last Name *

Student Registration Form

Customer Type* ---Select--- CCMA Student CCMA Parent

01) BASIC INFORMATION

Students Name (if parent)

02) Date of Birth *

03) Gender *

04) CONTACT INFORMATION

05) Prefered Method of Contact *

06) Mobile Phone Number *

07) Home Phone Number

08) Emergency Contact Name *

09) Who is this person to you? *

10a) Emergency Contact Number *

10b) Secondary Emergency Contact Number

11) CONSENT AND AVAILABILITY

12) Club Photography and Videography Consent * Please read our photography/videography policy before answering this question. https://closecombatmartialarts.com/photography-and-videography-policy/

12) PT Photography and Videography Consent * Please read our photography/videography policy before answering this question: https://fightingfitpt.com/photography-and-videography-policy/

13) Group Sessions Availability * Tuesday 6:15pm - 8:30pm | Thursday 6:15pm - 8:30pm | Friday 6:15pm - 8:30pm | Saturday 10:45am - 1:00pm

13) Availability for Personal Training Sessions *

13) How many times a week would you like to train? *

15) Height *

16) Weight *

17) Tshirt Type * Options: Unisex Short Sleeve or Ladyfit

21) MEDICAL HISTORY

22) Has your doctor ever said that you have a heart condition and that you should only do physical activity when recommended by a doctor? *

23) Do you feel pain in your chest when you do physical activity? *

24) In the past month, have you had chest pain when you were not doing physical activity? *

25) Do you lose balance because of dizziness or do you ever lose consciousness? *

26) Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

27) Are you on any medication (for example water pills) for your blood pressure or heart? *

28) Do you know any other reason why you should not do physical activity? *

29) Are you on any other medication? *

30) Please list medications:

31) History of Stroke? *

32) High blood pressure? *

33) History of high cholesterol? *

34) Family history of coronary heart disease? *

35) Obesity? *

36) Diabetes? *

37) Asthma, Breathing or Lung problems? *

38) Cancer? *

39) Allergies? *

40) Seizures, seizure medication, neurological problems or dizziness? *

41) Hernia or any condition that may be aggravated by exercise? *

42) Any injuries or surgeries in the past 3 years? *

43) Back problems, joint or muscle disorder still affecting you? *

44) Do you have any skeletal injuries? *

45) Do you smoke? *

46) Do you vape? *

47) Do you consume excessive alcohol? *

48) Chronic stress, depression anxiety or sleep disorder? *

49) Do you take supplements of any kind? *

50) If you answered yes to any of the above, please consult your doctor by phone or in person before you start training with us. Tell your doctor about this medical questionnaire, which questions you answered yes to and get advice about how to moderate your exercise. 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.

51) If you are filling out this form 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? *

52) FITNESS LEVEL AND GOALS

53) What are your fitness concerns or goals? * Weight loss | Strength | Endurance | Cardiovascular Fitness | Flexibility | Agility | Balance | Medical Concerns | Socialisation

54) How long has it been since you have exercised regularly? *

55) Do you participate in any other sports or physical training regularly? *

56) We are partnered with Close Combat Martial Arts, is this something that would interest you? *

56) STATEMENT OF TRUTH

57) I have truthfully filled out these forms to the best of my knowledge at this current time *

58) I understand it is my duty to report any changes to this information especially regarding my health. I will take every precaution necessary to maintain my own health and safety, taking advice from my doctor and instructor seriously. *

59) 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 *

59) I understand that I have to follow all instructions carefully in order to best reduce risk of injury *

60) 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 *

60) I confirm that I understand in full that any activity in which I participate will carry inherent risks associated. *

61) 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 *

61) I have read the Assumption of Risk notice and I wish to participate in sessions provided by Fighting Fit Personal Training and any registered instructors, coaches, or staff. *

62) 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 *

62) I confirm that I have familiarised myself with the FAQ page, Health and Safety Policy, Social Media Policy, Photography and Videography Policy and Our Safeguarding Policy. If I don't understand any of the information provided I will consult my Instructor *

63) 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 *

63) I confirm that I understand the nature of the activity in which I am about to participate, and I can agree that I am fit to participate and agree to assume all risks associated with the above, hereby withdrawing any liability from Fighting Fit Personal Training, instructors, association, or other relevant parties *

64) 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 *

65) 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 *

66) 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 *