On Line Registration Form
Name :
Father's Name :
Date of Birth :
Sex :
Permanent Address :
Telephone No. Resi :
E-mail Address :
Country :
Passport No
( for foreigners only )
Office :
Occupational Details :
Father's Occupation in Detail :
Office Address :
Reasons of Joining :
Previous Experience in Karate or any other Martial Art :
If you are applying for affiliation then please explain your previous history, your master National & International achievements or belts and strength of students and why do you want to join us. :
If so, the rank held :
Yes No
Are you medically fit to undergo strenuous exercise, if no please explain :
Yes No
State :
P.K.T.P. :
Yes No
Date :
Address of Dojo :
Class Time and Days :
  • Karate is for Self-Defence. If develops character patience, tolerance and humanity.
  • Karate emphasis on Speed of movement and keenness of mind.
  • Karate combines body with soul.
  • If the applicant is a minor (i.e. below 18 years of age) the application form should be countersigned by the parent or guardian.
  • The association or the instructor will not be responsible in any way for injury (physical or mental) received at or during the time of training of Karate or any other associated martial art nor is he responsible, when injuries are caused by its members of malpractised.
  • The grading test will be held once in 4 to 6 months. According to performance of student. Student must come in white - Gl.
  • Monthly fee must deposit on the date of admission, without covering the classes of month you have missed.
AGREEMENT : I will not use Karate for unlawful activities. I will not impart the training I receive without necessary permission from the Institution. I have carefully read the prospectus and I am agree to abide by the Rules and Regulations of the Institutions. On my misbehavior/indiscipline my membership stands cancelled. I will learn Karate at my own risk. My guardians don't have any objection for Karate training. In case of injury or damage or loss, if any, I myself will solely be responsible for the same.
NOTE : The form should be accompanied with two recent passport size photographs (including one to be affixed on the form). The chief Instructor or the instructors of the respective dojos have the poser to allow or reject any admission form without assigning any reason.
Information & Correspondence Office :
E-mail : shihan.naval@yahoo.co.in