MARTIAL ART INSTITUTE INTERNATIONAL
MEMBERSHIP APPLICATION FORM
Licence No. ___________________ Membership No. : _____________ Occupation:______________________________
Name: _________________________________________________________ Date of Birth: __________________________
Email:____________ Telephone: ____________________________________
Emergency Contact Person: ___________________ Relationship:________ Telephone: _____________________________
General Practitioner: ________________________ Address: _____________________________________________________
_________________________________________________________________ Telephone: _____________________________
Criminal Record (if applicable): _____________________________________________________________________________
Why do you wish learn martial arts? __________________________________________________________________________
Where did you hear about this club? __________________________________________________________________________
Any previous martial arts experience? _________________________________________________________________________
HEALTH (Please delete as appropriate Yes/No)
Have you ever suffered from: Details
1. Heart Disease or any other cardio-vascular problems? YES/NO _________________________________________
2. Do you have high/low blood pressure? YES/NO _________________________________________
3. Is there a family history of heart disease? YES/NO _________________________________________
4. Pain or tightness in the chest? YES/NO _________________________________________
5. Diabetes? YES/NO _________________________________________
6. Epilepsy? YES/NO _________________________________________
7. Asthma or breathing difficulties? YES/NO _________________________________________
8. Back pain/Joint discomfort? YES/NO _________________________________________
9. Which joint(s) is made worse by exercise? YES/NO _________________________________________
10. Osteoarthritis or Rheumatoid Arthritis? YES/NO _________________________________________
11. Do you have varicose veins? YES/NO _________________________________________
12. Have you been treated by a doctor in the last 6 weeks? YES/NO _________________________________________
13. Do you have any visual or hearing impairment? YES/NO _________________________________________
14. Have you been in hospital or had any operations recently? YES/NO _________________________________________
15. Are you taking any drugs or medication? YES/NO _________________________________________
16. Have you any medical condition which you think might
interfere with your participation in martial arts training? YES/NO _________________________________________
17. Have you been told by a doctor that you are overweight
or underweight? YES/NO _________________________________________
18. Do you smoke? If, so, how many? YES/NO _________________________________________
19. Do you drink more than 1 bottle of wine/6 pints beer
6 glasses of spirit a week? YES/NO _________________________________________
20. Are you physically active at work or outside? YES/NO _________________________________________
21. What sporting activity do you participate in at the moment and how often?
22. Is there any other aspect concerning your health you think the instructor should know about?
1. Martial Arts’ skills must not be used outside the club (Kwoon) or sporting arena against any other person with intention to cause injuries except under the circumstances of self-defence either to protect property or personal safety.
2. Under self-defence situation, only reasonable force must be used as defined by the Court of Law.
3. The martial arts licence must not be abused to justify carrying offensive weapon(s) in the public other than transporting it to and from the club for the sole purpose of training.
4. Uniform must be worn during training, examination, competition or any official representation of the Martial Art Institute International.
5. All participants must have insurance cover or licence by a national recognised governing body or reputable insurance company.
6. Traditional sign of respect must be displayed when entering or leaving the club (Kwoon).
7. Always pay your respect to your opponent before and after training.
8. Address your instructor according to the Kung Fu tradition as Si-Fu.
9. No foul language arising from bad temper is permitted in the club (Kwoon).
10. Bad attitude and temperamental behaviour that may cause offence to the instructor (Si-Fu) or the class will result in immediate termination of membership of the Martial Art Institute or club.
11. Ensure the training area is clean and tidy after use.
12. Make sure your instructor (Si-Fu) is updated with any illness or injuries you may have.
13. Tuition fees must be paid in advance each month; it is non-refundable and will not be credited for any period of absence. **Note** read joining up conditions. Prices are subject to change during the course of the yearly membership, and advance notice will be given.
I declare that to the best of my knowledge the information given is correct and that I know of no reason why I should not participate in martial arts training. I have read and agree to abide by the rules and conditions of the Martial Art Institute and I am aware that breach of the rules or conditions may result in termination of membership. I understand that I enter into any exercise programme entirely at my own risk and I waive any legal recourse for damages to myself that may arise from my participation.
Signed: __________________________________________________________ Date: __________________________________
Approved member (Official signatory): _______________________________ Date: __________________________________
Official Comments: _________________________________________________________________________________________
All cheques payments made payable to ‘HEI CHOI’, PO Box 628, Richmond, Surrey, TW9 1FF.