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Full Name

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Do you have more than one child that wishes to partake in the free trial?

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1st Student Details
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First Name *
Last Name *
Gender *
Date of Birth *

Day Month Year
Relevant Medical Conditions
Does your child have any special needs that we should be aware of?

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Please provide relevant details of special needs:
Does your child receive 1:1 support in school?

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It may be wise to have a chat with us to ensure that we can provide your child with the correct level of support in our class - certain classes may be better than others with regards to adult ratios for 1 to 1 support. Feel free to give us a call on 07921855900 and ask if you might be able to speak with Instructor Nick, regarding classes that might be best for 1:1 support.
What School Does Your Child Attend: *
Has your child ever earned a colour belt during school time, in one of our curriculum classes?

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What colour would that be?
Are they attending the straight after-school (youngest) class? *

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Would you like us to pick up from the school and walk them down to the hall? *

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Please sign here to confirm that you would like us to pick up from school and walk down to the hall *

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3rd Student Details (leave blank if only two)
Full Name

First Name Last Name
First Name
Last Name
Gender
Date of Birth

Day Month Year
Relevant Medical Conditions
Does your child have any special needs that we should be aware of?

Yes No
Please provide relevant details of special needs:
Does your child receive 1:1 support in school?

Yes No
It may be wise to have a chat with us to ensure that we can provide your child with the correct level of support in our class - certain classes may be better than others with regards to adult ratios for 1 to 1 support. Feel free to give us a call on 07921855900 and ask if you might be able to speak with Instructor Nick, regarding classes that might be best for 1:1 support.
What School Does Your Child Attend:
Are they attending the straight after-school (youngest) class? *

Yes No
Would you like us to pick up from the school and walk them down to the hall? *

Yes No
Please sign here to confirm that you would like us to pick up from school and walk down to the hall *

Clear