Student Infomation Form

Please complete the form below to request your licence and membership if transferring from another club or training with us and also elsewhere:

Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Medical Information *

Current TKD Rank *

Current BJJ Rank *

Acknowledgement *

Select to confirm the following:

I the trainee indemnify the Cobra Martial Arts Association and/or Phoenix SMA in respect of any injury caused to another member or against losses caused to the above mentioned by any act of mine or by default. I the trainee understand that the training and practice of the martial arts can be dangerous, and I agree personally to bear all losses caused by injury whilst engaged in it.