Instructor Membership Form (Monthly Payment)

1Basic Details

2School Details

3Compliance

4Payment

Hidden
Date Today

Day
Month
Year
Name*
First Last
Email*
Mobile*
Add country code if NZ
Date Of Birth*

Day
Month
Year
Gender*
- Female
- Male
Are you a school owner?*
- Yes
- No
Payment Type*
Are You The Nominated School Owner?*
If your school has multiple owners, nominate one owner as the main point of contact and fee payer. If you are not the nominated school owner, please go back and select 'Instructor' payment type.
- Yes
- No
Mailing Address*
Street Address City State/Territory Postcode Country
School Name
Other School
Or organisation if relevant
Current Grade*
Date of General Instructor Course Completion*
Or equivalent course

Day
Month
Year
Date Of Last Instructor Update*
If you have passed GIC within the past 9 months, put the same date as your GIC completion

Day
Month
Year
Date Of Last Successful Grading*

Day
Month
Year
Main Occupation*
Please provide your main occupation/work outside of Krav Maga or advise if you are a full time Krav Maga instructor
Emergency Contact Name*
Emergency Contact Mobile*
Photo*
Please upload a selfie
Accepted file types: jpg, png, jpeg, Max. file size: 128 MB.
Instructor T-Shirt Size (Dri-fit)*
Instructor Long Pants Size*

Save and Continue Later

School Owner Details
How many students do you have currently enrolled across all of your school locations?*
How many students do you have currently enrolled across all of your school locations? Price shown is per month. Annual payment option is available.
School Address*
Street address of your main school location

Street Address Address Line 2 City State / Province / Region Postcode Country
Are you paying Instructor Fees on behalf of your instructors?*
- Yes
- No
Number of instructors*
Total headcount of employed/contracted instructors (whether or not they are paid)
Would you like to include insurance as part of your school owner payment?*
Only available to Australian school owners at this time.
- Yes
- No
Provides:

-Public Liability $ 20,000,000 any one occurrence
-Products Liability $ 20,000,000 any one occurrence and in the annual aggregate in any one insured
-Sub Limits: Professional Indemnity $ 5,000,000 any one loss and in the annual aggregate any one insured
-Fines and Penalties $ 100,000
-OH&S Enquiries $ 10,000
-Care Custody & Control $ 50,000
Please select your insurance category*
Include all class, group, and personal training students
Brief Resume*
For the purposes of insurance, please provide a brief description or list of your qualifications as they relate to teaching Krav Maga

Save and Continue Later

Compliance Requirements
KMG requires that you provide this information as part of your ongoing membership as an instructor. If you are not current in any of these areas, you will have six months from the completion of this form to become up to date in each area.
Are you currently in paid government employment outside of KMG?*
If you are currently in an emergency services, military, or other position that routinely involves first aid training, regular criminal history checks, or allows exemption to WWCCs you may be exempt from providing some of these items. Please upload any relevant supporting documentation at the end of this form.
- Yes
- No
Please provide further details of possible exemptions*
Documents*
Please select the documents you currently hold
- First Aid Certificate
- CPR Certificate
- National Criminal History Check
- Working With Children Check
- Passport or Birth Certificate
- Drivers Licence
- Insurance Certificate/s (If Applicable)
First Aid Course Completion Date
The standard required is the nationally recognised course 'Provide First Aid (HLTAID003)'. Provide First Aid' which is valid for 3 years, and includes CPR.

Day
Month
Year
CPR Course Completion Date
Provide cardiopulmonary resuscitation (CPR) (HLTAID001) must be completed every 12 months between the full first aid course. If the completion date is the same as your first aid course, put the same date here.

Day
Month
Year
National History Check Completion Date
You will be required to produce a valid National Criminal History Check each time you re-register with KMG, or whenever the check exceeds three years since it was completed (whichever occurs sooner). If you do not currently hold a check, we recommend CV Check.

Day
Month
Year
Working With Children Check EXPIRY Date
You will be required to produce a valid Working With Children Check each time you re-register with KMG, or whenever the check expires in your state/territory (whichever occurs sooner). More Information Here.

Day
Month
Year
Insurance Expiry Date
If Applicable

Day
Month
Year
File Uploads
Please upload images or scans of all the documents selected in the checklist above
Drop files here or

Accepted file types: jpg, pdf, Max. file size: 128 MB.

Save and Continue Later

Payment*
Has your school owner already paid your fee on your behalf?
- No
- Yes
Total Monthly Fee (Inclusive of GST)
$ 0.00
Fee Payment*
Please enter your card details for payment. You will be billed immediately, and monthly after that.

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Email
This field is for validation purposes and should be left unchanged.

Save and Continue Later

School Owner Details

Compliance Requirements