pirit Taekwondo i 2005
Spirit Dojang School*
Terry Hill / GISS
Students Given names *
Intensions In Training:
Emergency Contact Name*
Emergency Contact Ph*
Emergency Contact Mobile*
Emergency Contact relationship to student*
Medical History: Do you suffer from any of the following conditions listed below?
Other: Please provide details below:
Medical condition: Other details - In the interest of your safety please list any medical conditions or injuries, as well as any medications you may require. Please note that a letter of approval from your doctor may be required prior to commencing training.
Behavioural Conditions : Please circle applicable condition
Other : Please provide details below:
Behavioural Conditions: Other
How did you hear about Spirit Taekwondo:
NOTICE AND WAIVER OF LIABILITY You are advised that all activities held within this centre can be dangerous and have obvious risks as defined by Civil Liability Amendment (Personal Responsibility Act.) By entering the premises and being actively involved you accept these risks as a part of general participation. YOU ARE PARTICIPATING AT YOUR OWN RISK OR ACCEPTING THE RISK ON BEHALF OF YOUR CHILD OR THE CHILD FOR WHICH YOU ARE GUARDIAN. By signing this form you state that you understand the risks and declare that, • I understand that all the activities of Spirit Taekwondo can be dangerous and there is a risk of injury, serious disability or death. • I accept that these activities are physically challenging and may cause abrasions, sprains, fractures, dislocations and other injuries. • I have considered the associated risks and agree to participate and accept the risks of injury or bodily harm. • I hereby release Spirit Taekwondo Pty Ltd, its staff and any assistants or any other person from any liability, demand, suit, claim or compensation due to any injury or damage to personal property that may occur whilst participating in all activities within the premises. • I am aware that this waiver applies to any further classes undertaken within the premises and furthermore accept that this document is contractual and may be relied upon in any further proceedings by me, my heirs, executors and assigns. • I am over the age of 18 am legally competent to sign this document OR I am a parent or guardian and competent to sign this document. • You accept and agree to abide by and follow all the rules, policies, procedures and conditions of Spirit Taekwondo. All policies are accessible at www.spirittaekwondo.com.au. Media consent : To be signed by parent or guardian if student is under 18 years of age I ______________________________________________ give my consent for Spirit Taekwondo to use any photographs or video footage that I or my child may appear in participating in Tae kwon do or at Taekwondo events. I understand this could be used for promotional materials, club year books, club memorabilia, club DVD’s, slideshow’s and the Spirit Taekwondo website.
STUDENT MEMBERSHIP and DECLARATION FORM