Karate For Life Membership Form
To be completed by all new and current members to Kwinana, Harrisdale & Baldivis Dojo 2019
Email address *
Please select which dojo you will be attending: *
Required
Please select the classes student will attend. See our timetable for locations. *
Required
Membership option *
Student's Full Name *
Your answer
Student's Date of Birth *
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Street Number and Name *
Your answer
Suburb *
Your answer
Post Code
Your answer
Mobile Phone Number *
Your answer
Occupation of Student (Adults)
Your answer
Is this the students first year at our karate club? *
If no what year did the student join? *
Your answer
What is the student's current rank? *
Your answer
Does the student have any injuries or illness's that may affect their training? Give details *
Your answer
Conditions of Training - 1.In these conditions: the association shall mean and include the Kofukan Karate Australia Association, its officer, servants or agents.2. In consideration of the Association accepting my application to train with Kwinana, Harrisdale or Baldivis Dojo and in further consideration of my fellow students, I hereby agree to abide by the conditions of entry, the rules, by-laws and regulations of the association.3. The association enters into this contract as the association and as agent for fellow students and instructors.4. I acknowledge that my participation in training carries with it a real risk of person injury.5. I acknowledge and agree that the association shall not be liable whether in tort or contract or otherwise for any loss or damage or injury whatsoever to my person or property whilst participation in or otherwise attending training howsoever caused or occurring including without limiting the forgoing, the negligence, breach of contract, wilful act or default of the association and whether or not such loss or damage or injury to me occurs within or adjacent to any property occupied by the association.6. I acknowledge and agree that my fellow students and instructors shall not be liable whether in tort or contract or otherwise for any loss or damage or injury whatsoever to my person or property whilst participation in or otherwise attending training, howsoever caused by or occurring including without limiting the forgoing, the negligence, breach of contract, wilful act or default of my opponent and where or not such loss or damage or injury to me occurs within or adjacent to my property occupied by the association.7. I authorize the association to contract on my behalf to exclude my liability as a fellow student or instructor whether such arises in tort or contract or otherwise for any loss or damage or injury to another competitor however caused or occurring including but without limiting the foregoing, the negligence, breach of contract, wilful act or default of myself.8. I expressly agree to and do hereby waive any rights that I may have which are in any way inconsistent with the foregoing. *
If student is under 18 Years - parent is to accept Conditions of training:1.In these conditions: the association shall mean and include the Kofukan Karate Australia Association, its officer, servants or agents.2. In consideration of the Association accepting my application to train within this Dojo and in further consideration of my fellow students, I hereby agree to abide by the conditions of entry, the rules, by-laws and regulations of the association.3.The association enters into this contract as the association and as agent for fellow students and instructors.4. I acknowledge that my participation in training carries with it a real risk of person injury.5.I acknowledge and agree that the association shall not be liable whether in tort or contract or otherwise for any loss or damage or injury whatsoever to my person or property whilst participation in or otherwise attending training howsoever caused or occurring including without limiting the forgoing, the negligence, breach of contract, wilful act or default of the association and whether or not such loss or damage or injury to me occurs within or adjacent to any property occupied by the association.6. I acknowledge and agree that my fellow students and instructors shall not be liable whether in tort or contract or otherwise for any loss or damage or injury whatsoever to my person or property whilst participation in or otherwise attending training, howsoever caused by or occurring including without limiting the forgoing, the negligence, breach of contract, wilful act or default of my opponent and where or not such loss or damage or injury to me occurs within or adjacent to my property occupied by the association.7. I authorize the association to contract on my behalf to exclude my liability as a fellow student or instructor whether such arises in tort or contract or otherwise for any loss or damage or injury to another competitor however caused or occurring including but without limiting the foregoing, the negligence, breach of contract, wilful act or default of myself.8. I expressly agree to and do hereby waive any rights that I may have which are in any way inconsistent with the foregoing.
PHOTOTGRAPH AGREEMENT: During different events, training, outings, tournament, grading etc. it is possible that you or your child will be photographed or videoed please state below whether or not you are happy for these images to be used to promote the club either via electronic or printed copy at any time in the future with or without their/your name included. Your wishes will be respected.I give permission for my child’s images to be used by Karate for Life and Kofukan Karate Australia. These images maybe used for promoting our club, future events and displayed on fund raising items such as calendars, t-shirts and other such items. *
By completing and returning this form a place will be held at the requested dojo for the student named above. An invoice will be generated for amounts associated with the cost of training and you will be added to our email list for notification of upcoming events. Please write the name of the person that completed this form on the line below.
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