Sign up - CA - Silverdale

Member Details

* Required field

* First name

* Last name

Gender

* Parent/Guardian's name

* Phone Number Add secondary Phone +

Secondary Phone

* Email Address Add secondary Email +

Secondary Email Address

* Date of birth

* Which class are you interested in?

* Students Name

Contacts

* Required field

* Contact Name

* Phone Number

Relation

Additional Contact

Photo

Edit Photo

Drag to reposition photo

Zoom

Rotate

Delete Photo Apply

Capture from camera No camera found. Please connect a camera to use this feature. Upload photo

Membership

Select
ADULT - 1 x class

Duration Ongoing
Access 1 sessions / week
Cost $25.00 / week + $25.00 signup fee
Programs Jiu Jitsu Adult, Kickboxing Adult, MMA Adult
Select
ADULT - Full Membership

Duration Ongoing
Access Unlimited
Cost $44.00 / week + $25.00 signup fee
Programs Jiu Jitsu Adult, Kickboxing Adult, MMA Adult
Select
KIDS - 1 x class

Duration Ongoing
Access 1 sessions / week
Cost $25.00 / week + $25.00 signup fee
Programs Jiu Jitsu Juniors (6-10yrs), Jiu Jitsu Youth (10-16yrs), Kickboxing Kids (8-14yrs), Mini Martials (4-6yrs)
Select
KIDS - Full Membership

Duration Ongoing
Access Unlimited
Cost $36.00 / week + $25.00 signup fee
Programs All Programs
Select
MULTIPLE KIDS - Membership

Duration Ongoing
Access Unlimited
Cost $36.00 / week + $25.00 signup fee
Programs All Programs

Membership Documents

Medical Conditions

Known Medical Conditions

How did you hear about us?

* Required

Who referred the member to us?

More details:

Account Password

Please pick a password to log-in to your account later.

Password (minimum 8 characters)

Confirm Password

Payment

Select membership first

Bank Account All transactions are secure and encrypted

Create a payment mandate to debit your bank account with one-time and recurring payments to CA - Silverdale.

Add Payment Mandate

Bank Name

Account Ending in

Payment will be provided later.

JOIN Coast Academy!

Member Details

Contacts

Photo

Edit Photo

Membership

ADULT - 1 x class

ADULT - Full Membership

KIDS - 1 x class