Membership Registration
Fill this form to become a member of Aikido of Westchester. There will be instructions for payment options upon submission.
Email address *
First & Last Name *
Your answer
This registration is for *
Not for you? Please type the first & last name
Your answer
Enrollee's Date of Birth *
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Home Address *
Please include street, city, state & zip
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Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Have you practiced a martial art before?
If yes, please describe along with the amount of time of practiced
Your answer
For USAF/IAF Members*
If you have practiced Aikido with the USAF or IAF, please answer questions below.
* Your Rank?
Your answer
* Your USAF number?
Your answer
* Your dojo(s) and teacher(s)?
Your answer
How did you hear about the Aikido of Westchester dojo? *
Select all that apply
Required
Hold Harmless Waiver
In consideration of being permitted to participate in any activity organized, administered or sponsored by Aikido of Westchester, I agree, on my own behalf, or, if appropriate, as a parent or guardian of the minor child named below as follows:
Aikido is a martial art. Practicing Aikido requires training with partners and involves physical risks; these include throwing, tumbling, pinning, joint immobilization, pressure on joints and the use of wooden weapons. As with any martial art, there is no way to eliminate the risk of injury inherent in Aikido practice. In consideration for the right to train at Aikido of Westchester, the undersigned agrees to release, discharge, covenant not to sue and agree to hold harmless, Aikido of Westchester, its instructors, officers, directors, and members from and against any loss, cost, expense, damage, or liability for any injury resulting from, or connected with the practice of Aikido.

I have read carefully and understood this agreement and that I fully agree with each statement contained in this agreement. I am aware that I may have the agreement reviewed by legal counsel prior to signing this agreement.
Your signature *
Type your full name
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Your Email *
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Date *
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Your Privacy
Your personal information is kept confidential and used only when contacting you to inform you of dojo related activities or to alert your emergency contact in case of an emergency in the course of your membership.
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