Enrolment We are always happy to answer any questions.Marcos 021 024 58413 | headsbjj@gmail.com MEMBERSHIP ACCOUNT DETAILS Select primary gym location * Please select your primary gym location but know that your membership gives you access to both locations. HQ gym, Walton Street, Whangarei City Taurikura Hall, Whangarei Heads Account Holder Name * Main contact for membership account. First Name Last Name Phone * This number will be added to the class WhatsApp group. (###) ### #### Email * STUDENT DETAILS Student 1 * First Name Last Name Year of birth For KID 1 and 2 program students please Please advise any health, physical or learning requirements that we should be aware of Such as chronic injury, severe asthma etc Select program * KID 1 KID 2 ADULT LADIES Start date * MM DD YYYY Student 2 First Name Last Name Year of birth For KID 1 and 2 program students please Please advise any health, physical or learning requirements that we should be aware of Such as chronic injury, severe asthma etc Select program KID 1 KID 2 ADULT LADIES Start date MM DD YYYY Notes / message Please use this section to enrol any additional students. EMERGENCY CONTACTS Please provide at least one emergency contact. Emergency contact 1 * First Name Last Name Emergency contact phone * (###) ### #### Emergency contact 2 First Name Last Name Emergency contact phone (###) ### #### Your enrolment form has been submitted. You should receive an email within the next 24 hours containing some information and a payment link to complete your enrolment. This email is sent to the email address you have provided under the account holder section.If you do not receive a reply from us within 24 hours, please check your spam box. If still nothing there, please let us know.We look forward to seeing you on the mats!
