STUDENT DETAILS FORM

Student Details

* Indicates required field

Student Name *

First

Last

Student Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

First

Last

Contact Mobile Number *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Number *

Illness/Injuries *

Allergies *

Other Health Information *

Medical Practitioner Name *

Medical Practitioner Number *

Current Ambulance Insurance *

The information above is correct to the best of my knowledge *

Yes

Submit

Location

Aikido Arts South Kingsville

43 Paxton Steet, South Kingsville
Backing on to Edwards Reserve

Mobile Telephone
0404 028 205

A BIT ABOUT US

Aikido Goshinkai Melbourne Dojo provides a secure, friendly environment where we can begin to see and understand our fears, anxieties, reactions and habits. The concentration and discipline required for Aikido training brings focus to our daily lives. Aikido challenges us to improve our skills and attempt new things.