Martial Arts Practitioner Health Statement Form
Personal Information
Full Name
Date of Birth
Contact Number
Emergency Contact Name
Emergency Contact Phone
Health Profile
Do you have or have you ever had any of the following conditions?
Asthma
Heart Disease
Diabetes
Epilepsy
Serious Injury
Allergies
None
Other medical conditions or anything we should know about?
Are you currently taking any medications?
Physical Activity Readiness
Are there any physical limitations or concerns related to participating in martial arts?
Declaration
I declare that the information provided is accurate and complete to the best of my knowledge.
Signature (Name)
Date