Admission | Mike's Martial Arts

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MIKES MARTIAL ARTS ADMISSION FORM

First name*

Last name*

Email*

Phone*

Date of Birth*

Day

Month

Year

Date of Admission*

Day

Month

Year

Home Address*

Health issues or surgeries in past two years and ongoing medication if any?*

Blood Group*

Height in feet and inches?*

Weight in Kg?*

Profession (Employer Details and Designation)? In the case of a student, name of insititution and class?

Guardian's Name?

Guardian's Phone Number

Upload Photograph*

Add single jpeg image less than 1 mb

Upload Identification Card (Aadhar or Passport)*

Add single pdf or jpeg less than 1 mb

Choose your Discipline (multiple choice possible)

Kyokushin Karate

Shotokan Karate

Kickboxing

Brazilian Jiu Jitsu

Boxing

Gymnasium

Personal Training

Online Classes

Choose your Dojo*

Sarat Bose Road, Kolkata

Kasba, Kolkata

Both

Online Classes

Your Martial Arts Experience

Beginner

Intermediate

Advanced

Please mention your prior training details if any, such as belt / rank / name of previous training academy or coach?*

Where did you hear about us? (Ex. Instagram, Facebook, Google Search, Signboard or Referral from friend / relative)*

I have read and understood the terms and conditions associated with Mikes Martial Arts Liability Waiver

Signature*

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+91 98740 23648 / +91 98315 07676

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