Evolve MA Membership Registration Form

Students Name*

First NameLast Name

Birth Date (ages 3+)*

DayMonthYear

Sex*

MaleFemale

Has the student taken Martial Arts classes before?*

YesNo

what Art have they studied?

If yes, what Grade are they currently?

Does the above named Student have any medical history or conditions and/or learning difficulties, that could affect their ability to participate in contact sports?*

NoYes (Please enter details below)

Medical Conditions*

Parent or Legal Guardian *

PrefixFirst NameLast Name

Landline Phone Number:

Area CodePhone Number

Address:*

House Name or Number

Street Address

TownCounty

Post Code

Mobile Number:*

Mobile Phone Number

E-mail (for club newsletters and invoicing)*

Emergency Contact*

PrefixFirst NameLast Name

Emergency Contact Landline Phone Number

Area CodePhone Number

Emergency Contact Mobile Number*

Mobile Phone Number

Where did you hear about us?*

Monthly Fees

1. All fees are to be paid in advance of lessons via standing order between the 1st – 3rd of each calendar month. The fees are pro-rata to 48 weeks to the year. We have a two-week break over Christmas and another two-week break at the end of summer.

2. Monthly Fees are:

a. 1 session a week is £28 a month.

b. 2 or more sessions a week is £38 a month.

c. There is a sibling discount of £5 per additional child.

d. There is a Military Discount of £3.00 for each child that has a Serving MOD parent or Guardian.

e. Only 1 type of discount may be applied at any one time.

Payment

3. Your first payment will be calculated dependant on what week of the month you register this will be calculated by how many weeks are remaining in that particular month minus your 1-week free trial.

4. An initial payment will be due on or before the second full week of sessions commencing.

5. Payments will then be made monthly via Standing order between the 1st – 3rd of every calendar month.

6. Failure to pay may incur a Service Charge of £5 for the first month of non-payment, and £10 for any following months that the payment owed is not paid.

7. Should you refuse to pay within one month then you forfeit the students right to participate in training and the student will unfortunately not be allowed to train with us until all payments and fees have been paid.

8. By agreeing to these terms and conditions, I hereby agree that Evolve MA has the right to refuse service to those who are not up to date with payments, as well as for those who continually make late payments.

Lesson Packages. Please select as applicable*

1 x 30 minute Mini Ninja Session Per Week Aylesbury (28.00)1 x 1 Hour Session Per Week Aylesbury Classes (£28.00)2 or more x 1 Hour Session Per Week Aylesbury classes only (£38.00)1 x 1 Hour Session Per Week Ambrosden Classes (£28.00)1 x 30 Minute Mini Ninja Session Per Week Ambrosden (£28.00)1 x £3.00 Military Discount (Serving MOD)1 x £5.00 Sibling Discount

Which classes will the student be attending? Please tick all that are applicable.*

Evolve MA takes the security of your data very seriously.

Evolve MA only requests the information it needs to provide the service.

Evolve MA will never share your data with any other business or individual without your express permission.

The Data Protection Officer (DPO) controling Data Protection is:

Mrs Emma Payne

Your Data is used soley by Evolve MA to ensure it delivers to you the customer.

All JotForm standalone form links and embed codes are secure (SSL) by default, and they give all users the option to encrypt their data, which Evlove MA have done. JotForm also adheres to strict European data protection laws by allowing users to store their data on secure German servers if they choose, again Evolve MA have done this.

An EU Safe Form is a form that is served from JotForm’s European servers in Germany. When the form data is submitted it is stored in JotForm’s European servers and the data can only be accessed from JotForm’s European site. The data is never transferred to the US.

Note that a EU Safe Form is only safe if you are a JotForm user in Europe.

Any requests for your personnel data held by Evolve MA must be done in writing stating the information that you require.

Signature of Parent/Legal Guardian*

Student Registration

Students Details

Parent or Legal Guardian's Contact Details

Emergency Contact details

Monthly Fees

GDPR