Become a member | Westside Judo

Please fill out the form below and one of our team will contact you shortly.

When would you like you child to start classes*
- As soon as possiable
- At the beginning od next term
- After a specific date
I would like my child to start Judo classes after the below date*
Date Format: DD slash MM slash YYYY
Name of Child*
First Last
What is their current age?*
Date of Birth*
Date Format: DD slash MM slash YYYY
Home Address*
Street Address Address Line 2 City ZIP / Postal Code

If more than one home use the adress of the place child lives most of the time and where you would like to receive any correspondence.
Parent/Guardian Details
Name
First Last
Home Phone
Mobile Phone*
Work Phone
Email
Add another parent/guardian
- I would like to add another parent/guardian
Name
First Last
Home Phone
Mobile Phone
Work Phone
Email
Additional Info
Please list any special behaviours/medical conditions/injuries/medications to be administered, or anything else you believe our Sensei should be aware of:
We will most likely call you to discuss any needs further.
I/we give permission for our child(ren) to have their photo and name to be used in any marketing and or publicity media like Westsides website, newspaper articles etc.*
- Yes
- No
- Please contact me on a case by case basis

Parent/Guardian Details