Register Student - NTC Derby

New Student Registration Form

Please fill the form below to register a new student. When you finish, click submit and we will contact you back soon with further information.

Student Full Name *

Date of Birth *

Gender

Male
Female
Other
I prefer not to say

Address *

Address Line 1

City

State / Province / Region

Student Phone

Parent/Guardian Details (For children)

Parent/Guardian Name

Parent/Guardian Email

Phone

Emergency Contact

Name *

Phone *

Any Medical Concerns

Details

I have read and agree to the Terms of Service Agreement listed below:

I herby certify that I am in normal health and capable of safe participation in the Taekwondo classes at National Taekwondo Club.
I assume all risk(s) and hazards incidental to the conduct of Taekwondo classes.
I herby authorize the National Taekwondo Club – Derby and the instructor/assistants to obtain medical treatment for me in the event emergency. I understand that the purpose of martial arts is to improve physical fitness, mental awareness and develop self discipline and self defence skills. I understand that some facets of the program may involve bodily contact and is aware of the risks and hazards inherent in such activities. I agree that he or she will not hold the club, Sunnyhill Community Centre, Instructors or any other student responsible for injuries sustained during activities authorized by the club. I will act responsibly, to ensure the safety of them self and others. The club reserves the right to sideline or expel any student for unsafe, unlawful or disruptive behaviour.
Any photographs or motion pictures taken during the l Taekwondo program activities may be used for promotional purposes and shared with other parents and other branches of National Taekwondo Clubs,