ICP(Inline Certification Program) KOREA Application Form
Fill it out by English only. Edited by Moon, ICP International examiner.
Please contact Mr Cho, Korea Coordinator and Examiner ℡: 010-6228-0410 if you have any queries.
Level Applied For(Circle)
Head Instructor (in Korea only)
Full Name (first & last name)
ex) Hong, Gil-dong
Date of Birth (dd/mm/yy)
ex) 서울 양천구 목동 908-31 목동프라자 703호
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.
Yes, I have read and understand.
Type your full legal name and/or legal guardian
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