Membership Form

Name *

Parent/Guardian’s Email *

Home Telephone *

Mobile *

Address *

Date of Birth *

Age *

Grade *

Gender *

Membership Number (in licence book) *

Have you any Special Needs, Disability, Injuries/Weakness or Illness? *

Please supply summary, but inform your instructor of all details if there is medication required in regarding to Allergies/Diabetics etc

Signature *

WTF taekwondo is a full contact sport and there is a risk of injury I acknowledge that I have been informed of the nature and potential risks of practising Taekwondo. I apply for membership to the ITU and agree to comply with the rules and regulations of the board.

Parent/Guardian’s Signature *

To be completed by the parent or guardian for all applicants under 18 years of age: I acknowledge that I have been informed of the nature and potential risks of practising Taekwondo. I agree to my son/daughter applying for membership to the ITU. If you are over 18 then please put your won signature again.

Club Name: Ilyo Taekwondo Club

Instructors Name: Paul Sheridan

Instructors Contact No.: 0860377587

Signed: Paul Sheridan Chief Instructor