Enquiries - Kenshinryu Aikido Martial Arts

Feel free to contact us at the main Dojo for any information or queries,
or fill out the below form to be contacted by a member of staff.
3 -5 Briggs Street, Palmwoods, QLD, 4555

Tel: (07) 5445 9116
Email: info@kenshin.com.au

Please complete the form below, including selecting the program/discipline you are interested in.

Membership Application Form

Which martial art are you interested in? *

Name *

First

Last

Date Of Birth (dd/mm/yy) *

Address *

Day Phone / Mobile *

Email *

Do you wish to receive Kenshinryu's monthly newsletter? *

How did you hear about us?

Google Search
Yellow Pages
Word of Mouth

Occupation

Previous Martial Arts Experience (what Martial Art, Organisation & Level achieved. Write none if not applicable)

Hobbies

Have you ever been excluded from Martial Arts in the past by a medical practitioner or any other person or entity in a martial arts club? If yes please give details. If no please leave blank.

Please list any known injuries

Please list any known conditions or allergies

Please list any required medication or special needs

Do you take prescribed drugs which may impair reaction time or judgement? If yes please give details.

Please choose a DAY which suits you for your follow up interview. *

Please choose a TIME which best suits you for your follow up interview *