top of page

Home
About
Astros for 4-6 year olds
Family Classes
Join
Shop
Gift Card
FAQ
More

Use tab to navigate through the menu items.

Licence Application

Contact Details

Student's Name*

Student's Address*

Postcode*

Mobile Number*

Email*

Date of Birth*

Occupation

Next of Kin Details (Guardian if Under 18)

Name

Phone

Email

Relationship to Student

Licence / Grade Details

Current Licence Number (if applicable)

Current Licence Expiry Date (if applicable)

Grade / Kup

Date Training Commenced

Club*

Martley

Wolverhampton

Sandwell

Gender:*

Male

Female

Training Age*

Senior (16 and Over)

Junior (Under 16)

Health

Do You Suffer from Any of the Following*

Heart Disorders

Hay Fever

Asthma

Diabetes

Migraine

Epilepsy/Fits/Faints/Blackouts

Neurological Conditions

Haemophilia

Learning Difficulties/Disabilities

None of the Above or N/A

Other Physical Injuries/Disabilities

Convictions

Have You Ever Been Convicted of a Violent Crime*

Yes

No

Have You Ever Been Refused Membership of Any Martial Arts Club?*

Yes

No

Disclaimer

I agree to abide by the rules and regulations of the ITS (Independent Taekwondo Schools) and I understand that Martial Arts can carry a risk of injury

I consent to the information set down here and other essential information relating to my progress in martial arts and involvement in Verve Martial Arts (Verve MA) being kept confidentially by Verve Martial Arts, its affiliates and the ITS.

I understand it is a regular practice for photographs and videos from selected events and classes to be used in Verve MA or ITS newsletters, publications, websites and marketing materials. All materials remain the copyright of Verve MA.

Do you consent to having your photo taken and shared?*

Students may opt out at any point.

This information may not be passed on to any third parties.

Other Information

How Did You Find Out About Us?*

Student's Signature (Guardian if Under 18)*

Date Signed*

Email: info.dtkd@gmail.com | Call/WhatsApp: 03300433447

bottom of page