Why are you interested in learning KARATE … ... I would like to enroll myself as a
registered student under your ASSAM SHITO RYU KARATE.
ASSAM SHITO RYU KARATE ASSOCIATION Regd No.1715 Registered Office: Station Road, Guwahati -781 001 ASKA affiliated to Japan Karate Do Kino Ryu India(JKKRI) JKKRI approved by Karate Do Federation of India(KAI) KAI affiliated to World Karate Federation(WKF) WKF recognised by International Olympic Committee(IOC)
ADMISSION FORM
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1. Name (in block letters) ………………………………………………………………………………………………. 2. Father’s Name…………………………………………………………………………………………..……..………… 3. Guardian’s Name …………………………………………………………………………..………………..………… 4. Date of Birth ……………………………………………………………………………….………………….………… 5. Present Address ……………………………………………………………………….…………………….………… 6. Permanent Address ……………………………………………………………………………………….…………. 7. Contact No …………………………………………………………………………………………………….…………. 8. Identification mark a)………………………..…………. b) …………………….……………………………….. 9. Caste ……………………………………………………………………………………………….……………………….. 10. Nationality ……………………………………………………………………………………………………………….. 11. Why are you interested in learning KARATE ………………………………………………..………….. ……………………………………………………………………………………………………………………..………….. I would like to enroll myself as a registered student under your ASSAM SHITO RYU KARATE ASSOCIATION(ASKA) and hereby pledge to obey the rules and regulations of the Association. I am fully aware that ASKA reserves the right to expel or terminate my membership if I am found to have violated rules & regulations of the Association. I shall solely be responsible for any injury/injuries that may be sustained during my training/coaching camp/tournaments. I further declare that all the above stated information is true to the best of my knowledge and belief. Date: Place: ---------------------------------------Signature of Parent / Guardian
-----------------------------Signature of Applicant
