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Sparring Ninjutsu Shinbukan_edited_edite

Shinbukan
Traditional Japanese Cultural & Martial Arts Academy in Lane Cove est. 1978
Karate and Ninjutsu taught with structure, control and calm awareness.

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Shinbukan Membership Registration

Please complete the following form to apply for membership. All information is confidential and used in accordance with academy policy.

First name*

Last name*

Birthday*

Day

Month

Year

Address*

Phone*

Email*

Health Declaration

Declare any health or medical conditions that may affect participation.

On Impairing Medication

Medication Details

Recent Medical Procedure

Medical Procedure Details

Recent Incapacity / Medical Attention

Physical Impairments / Injuries / Medical Conditions

Health Issues Academy Should Know

Health Issues Description

Martial Arts History

Tell us about any prior martial arts experience.

Studied Martial Arts Before

Previous Martial Arts Style

Previous Grade Achieved

Years Studied

Previous Instructor

Exclusion from Martial Arts

Disclose any previous exclusions from martial arts training.

Previously Excluded from Martial Arts

Guardian Information (if under 18)

To be completed if the applicant is under 18 years of age.

Guardian Name

Guardian Relationship

Guardian Address

Membership Details

For office use or advanced applicants. Specify membership type and record-keeping details.

Current Belt/Grade

Membership Type*

Kids Karate

Adults Karate

Ninjitsu

Join Date*

Martial Arts Agreement/Indemnity and Terms & Conditions

https://www.shinbukan.com.au/terms-conditions

Declaration*

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By signing this box, I confirm that I have read and agree to the Indemnity and Terms & Conditions as outlined in the link above.

0417884131

151 Burns Bay Road, Lane Cove, NSW 2066

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Shinbukan Traditional Japanese Cultural & Martial Arts Academy in Lane Cove est. 1978 Karate and Ninjutsu taught with structure, control and calm awareness. ​​