Freestyle Judo South Africa Organization Alliance Enrolment Form

First Steps Academy Registration Form
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Freestyle Judo South Africa Organization Alliance

(FJSAOA)
Enrolment Date

MonthDayYear
Date Approved

MonthDayYear
Training Days*
Student Information

Judoka
First Name*
Last Name*
South African I.D Number*
South African Passport Number*
Other Identification Number*
Country*
Gender*

FemaleMale
Birth Date*

MonthDayYear
Home Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Medical Aid Name.#*
Medical number. #*
Medical Aid Option. #*
Main Members I.D No. #*
Doctors Name*

First NameLast Name
Doctors Phone Number*

Area CodePhone Number
Parent/Guardian/Information 1

Mother's Details
Full Name*

First NameLast Name
I.D. Number*

SA Green Book/Card I.D. No.
Home*

Area CodePhone Number
Cell

Area CodePhone Number
Work

Area CodePhone Number
E-mail*
Address - Same As Child*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 2

Father's Details
Full Name

First NameLast Name
I.D. Number

SA Green Book/Card No.
Home

Area CodePhone Number
Cell

Area CodePhone Number
Work

Area CodePhone Number
E-mail
Address - Same As Childs

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Information
Have you Done Judo Before

YesNo
Where: Club Name and Rank
Have you participated or are you involved in other Martial Arts*

YesNo
What type of Martial Arts, Rank, Club Name, Instructor / Coach Name
Martial Arts License / Record / Grading Book No
Does your child have any allergies?*

YesNo
If yes please list, including any food or drug allergies.
Does your child have any medical conditions?
Does your child require any medication? If yes, please list these medications.
Do you authorize us to administer the medications listed above?

YesNo
Please list the people authorized to pick up your child.
Does your child have any siblings?*
If yes, what is their age(s)?
Comments
If yes, which one?
Emergency Contact - Other than Parent/Guardian
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home*

Area CodePhone Number
Cell

Area CodePhone Number
Work

Area CodePhone Number
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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Email
example@example.com
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Email
example@example.com
Should be Empty:

First Steps Academy Registration Form

Freestyle Judo South Africa Organization Alliance

Student Information

Parent/Guardian/Information 1

Parent/Guardian Information 2

Other Information

Emergency Contact - Other than Parent/Guardian

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