Shintaikudokaikan Karate
MEMBERSHIP APPLICATION
NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
DATES OF BIRTH : _ _/_ _/_ _ _ _ AGE : _ _ _
ADDRESS : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TELEPHONE : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
EMAIL : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1. Whilst all care is taken by the Shintaikudokaikan Karate , karate is a contact sport and a dangerous recreational activity and injuries, including but not limited to permanent disability, can occur. I fully understand that the Shintaikudokaikan Karate Organizations accepts no responsibilities for any injuries incurred, & agree to abide by all rules of the Shintaikudokaikan Karate Organizations . I also agree to do what I am told when I am told & how I am told.
2. I, the undersigned in consideration, & a condition of acceptance of my entry of the above school for myself, my heirs, executors & administrators, hereby waive all & any claims, right of cause or action which I or they might otherwise have, arisen out of any life or injury, damage or loss of any description whatsoever which I may sustain in the course of or consequent upon my entry or partition in the said school.
3. I agree to allow photographs or images of myself/my child to be placed on the Shintaikudokaikan Karate Organizations website and to otherwise be used for promotional or instructive purposes.
4. This waiver, release & discharge shall be & operates in favour of all persons, corporations & bodies involved or otherwise engaged in promoting or staging the event & the servants, agents, representatives & officers of any of them.
BY SIGNING THIS FORM I HAVE READ, UNDERSTOOD & AGREE TO ALL OF THE ABOVE :
Signature of Applicant Date
Signature of Parent or Guardian for applicants under 18 years old Date
