Licence Application Form
Step 1 of 3: Submit
Please complete the form in full.
First Name
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Surname
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Date of Birth
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Address
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Post Code
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E-mail
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Mobile Number
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Medical Condition
If you feel you have any medical condition that may affect your training, it is your responsibility to consult your doctor and you must inform your instructor BEFORE undertaking any exercise.
You must provide details below of any medical condition (eg - Asthma )
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Please select current grade
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Select an option:
18th Kyu - Beginner (White Belt)
17th Kyu - White / Red Stripe
16th Kyu - White / Yellow Stripe
15th Kyu - Red Belt
14th Kyu - Red Belt / White Stripe Belt
13th Kyu - Yellow Belt
12th Kyu - Yellow Belt / White Stripe Belt
11th Kyu - Orange Belt
10th Kyu - Orange Belt / White Stripe Belt
9th Kyu - Green Belt
8th Kyu - Green Belt / White Stripe Belt
7th Kyu - Blue Belt
6th Kyu - Blue / White Stripe Belt
5th Kyu - Purple Belt
4th Kyu - Purple / White Stripe Belt
3rd Kyu - Brown Belt
2nd Kyu - Brown / White Stripe Belt
1st Kyu - Brown / 2 White Stripe Belt
1st Dan - Junior Black Belt
1st Dan - Black Belt
2nd Dan -Junior Black Belt
2nd Dan - Black Belt
3rd Dan - Junior Black Belt
3rd Dan - Black Belt
Please select required licence
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Select an option:
Child Licence (£45.00 GBP)
Adult Licence (£49.00 GBP)
Please submit one official passport photo for the licence book
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Select an option:
I will submit one passport photo in class
Please select your dojo location or school club name?
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Select an option:
Collier Row Dojo
Chingford Dojo
Chigwell Dojo
Enfield Dojo
Epping Dojo
Barkingside Dojo
North Romford Dojo
Enfield Heights Academy
Kingfisher Hall Academy
Woodpecker Hall Academy
Carterhatch Junior School
St Mary's Catholic Primary
Gilbert Colvin Primary
Brimsdown Primary
George Spicer Primary
Club Membership Terms & Conditions
Do you agree to all of the following membership rules?
It is your responsibility to check for lesson updates, venue information plus school holiday course dates on JHKA.CO.UK
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All communication must be sent via email to JHKA Office
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You accept that our lesson fees are based on 12 monthly instalment payments for 44 weeks of Karate training
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You accept that as part of the 12 monthly instalment plan, all 12 instalments including August is due regardless of any holidays planned or non attendance
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You accept that all payments are to be paid on the first of each month by direct debit or in some cases by standing order
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If for any reason a lesson is cancelled, you agree to attend training at the next nearest JHKA venue during that week or the following
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You accept that you must give at least 1 month notice and 1 month full payment should you wish to terminate membership with JHKA
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Declaration (Parent /Guardian to sign if applicant under 18 years)
1.) It is my responsibility to ensure that i have an up to date licence.
2.) I do not have any medical conditions that would prevent me from taking part in strenuous exercise.
3.) I have never been convicted of a violent crime
4.) I accept that practising a Martial Art, may involve a risk of injury.
5.) I consent to the use of photography for promotional purposes (eg. JHKA & FKA websites)
6.) Should any classes stop running due to a pandemic or similar situation, you agree to continue your training using the online training platform which will be organised by Chief Instructor temporarily until normal classes resume.
Do you consent to the T&C above?
Consent
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Select an option:
Yes I Agree to the T&C above
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