Goju Kai Karate Do Sydney inc Membership Waiver Form

Full Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

City

Zip Code

State*

Phone Number:*

E-mail (for club notices)*

example@example.com

Birth Date *

YearMonthDay

Male / Female*

Parent or Legal Guardian (if Applicant a Child ie U/18):

First NameLast Name

Emergency Contact*

First NameLast Name

Relationship:*

Emergency Contact Phone Number*

Are you a existing member of GojuKai Karate Do Sydney Inc

YesNo

Which Dojo is the primary place you will train?*

Have you taken Martial Arts classes before?

YesNo

Previous Martial Arts Experience

What Karate rank are you currently?

New Applicants Only: Please provide details

(style, years, grade, location, instructor & their contact details)

Goju Kai Karate Do Sydney Inc (“Club”) conducts Karate / Kobujutsu (weapons training), a physically demanding contact sport (recreational activity) in which participants risk injury. The applicant must tell the Club whether they are fit to undertake Karate / Kobujutsu by answering the following:

Q 1. Has a medical doctor or other health professional ever advised the applicant against taking part in Karate/ Kobujutsu or any other martial art or sporting activity?*

YesNo

Q 1. If you answer yes please provide details:

If you answer yes you must provide a medical certificate stating it is safe for you to take part in Karate / Kobujutsu.

Q 2. Has the applicant ever been excluded by any karate / kobujutsu or martial art or other sporting / fitness organization / group from taking part in their activities on health grounds?*

YesNo

Q 2. If you answer yes please provide details:

If you answer yes you may be asked to provide a medical certificate stating it is safe for you to take part in Karate / Kobujutsu.

Q. 3. Is there anything about the applicant’s health that could reasonably affect them training safely in karate / kobujutsu or that could reasonably affect others training safely with them?*

YesNo

Q 3. If you answer yes please provide details:

If you answer yes you may be asked to provide a medical certificate stating it is safe for you to take part in Karate / Kobujutsu.

Q. 4. Does the applicant suffer from anaphylaxis?*

YesNo

Q. 4. Part 2 In case of incident may Club agents use EPI Pen on you?

YesNo

Q 4. Part 3 EPI Pen location while at training (if applicable):

Q. 5. Does the applicant suffer from asthma?*

YesNo

Attach asthma plan (if applicable):

Q. 5 part 2. In case of incident may Club agents use Asthma Puffer on you?

YesNo

Asthma Puffer location while at training:

Q 6. Does the applicant wear contact lenses/glasses while training?*

YesNo

Specify if contacts / glasses

If answer is other please provide details:

Q 7. Is the applicant pregnant or likely to be pregnant?

YesNo

If you answer yes you must provide a medical certificate stating it is safe for you to take part in Karate / Kobujutsu.

1. The applicant agrees to the terms in this Part applying with ongoing effect in consideration of participating in Club training in Karate / Kobujutsu and other activities at Club dojos and venues.

2. The applicant submits this application for the category of:*

(There are 3 categories...please scroll through all menu choices)

Type of Visitor:

3. The applicant warrants:

a. all the information provided is correct and complete, knowing that it will be relied on by the Club in determining whether or not to approve; and

b. any subsequent changes to any of the information provided will be notified to the Club as soon as possible as part of the applicant’s ongoing obligation.

4. An applicant who is approved by the Club becomes entitled to participate within their category for the Period subject to the following, namely that they:

a. take notice of and abide by the Constitution of Goju Kai Karate Do Sydney Inc (“Club”) available at ;

b. comply with all rules and regulations of the Club and IKGA;

c. obey instructions from any Club instructors, their assistants, and officials; and

d. provide the Club with the Waiver and Indemnity in Part 3.

5. New membership applicants, if approved, have the status of provisional members of the Club and are required to pay Club subscriptions and training fees or be paid remuneration as appropriate. Provisional members are subject to further approval by the Committee in order to become members, and membership is not automatically guaranteed.

6. Other applicants may be renewing members and visitors who are required to pay Club subscriptions and training and other fees or be paid remuneration as appropriate.

7. The applicant and the Club hereby agree that either or both of them will have recourse only to the law and courts of NSW in any matter concerning this application and the Club constitution.

I am giving this waiver of liability and indemnity for:*

In the case of my child I have explained to them that Karate / Kobujutsu is a dangerous and risky activity in which it is possible they may get hurt

YesNo

I realize that:

The Karate / Kobujutsu activities undertaken by the Club involve physical contact between instructors and students and between students and students that makes it a demanding activity with risk of injury; and
Club activities always involve the risk of injury to all participants who choose to involve themselves entirely of their own free will;
The Club as used in this Part includes any of its officers, committee members including its Executive and Patron, members in any category, visitors, instructors or their assistants, founding members, and anyone who assists the former in the conduct of Club activities including the supplier of any venue;
“I”, “me” and “my” as used in this part means “myself” and extends to include my child as appropriate; and
“We”, “us” and “our” as used in this part means “the Club and I”.

Waiver and Indemnity:

Accepting the foregoing in this Part and in consideration of my participating in the Club to learn practise instruct Karate / Kobujutsu and / or engage in other activities, so far as is lawfully permitted for the Period and with continuing effect thereafter, in applying to be a Member or Visitor of the Club, I acknowledge that there are inherent and obvious risks from my involvement in Karate / Kobujutsu training being a dangerous recreational activity in which I may suffer loss and injury and I waive any and all claims for liability that may arise against the Club.

I duly agree to release and indemnify the Club, its instructors, officials and associated International Karate Do Goju Kai Association (IKGA) from any and all claims, liability for injury, loss or damage, however caused, arising out of or associated with my participation in any of the Club’s training in Karate / Kobujutsu or its other activities.

We agree that this Waiver and Indemnity may be pleaded as a full and complete bar to any action, suit or proceeding commenced now or taken at any time by or on behalf of me with respect to or in any way connected with the conduct of the Club’s activities.

The applicant declares that they:

Have read, understood and accepted: this Membership and Visitor Application & Waiver and Indemnity for the Period; and the Club Introduction & Dojo Rules (the latter being displayed at the time of application on the Club website at www.karatesydney.com), or
In the case of a child applicant both part 2 and part 3 have been read, understood and accepted by the responsible parent on behalf of their child (to whom they have explained them).

Signature of applicant*

Clear

Use your cursor to draw your signature.

Date

(Electronic version 1, 1.7.20)

Goju Kai Karate Do Sydney inc

PART 1 – APPLICANT PERSONAL INFORMATION

Applicant’s Health:

PART 2 – TERMS

PART 3 - WAIVER OF LIABILITY & INDEMNITY

PART 4 - DECLARATION