Fuzion Martial Arts Academy Chingford New Student Enquiry & PAR Q

WELCOME TO THE THE FUZION MARTIAL ARTS ACADEMY CHINGFORD

Please Fill In This New Student Enquiry Form

Date Of Birth*

Name*

First NameLast Name

Mobile*

Email*

Your Message*

Please read the following questions carefully and tick (X) next to the appropriate answers. Answer all questions honestly and to the best of your ability.

YES/ NO QUESTIONS*

	Yes	No
Has your doctor ever said that you have a heart condition (had a stroke, heart attack, or heart surgery) and/ or that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Are you pregnant now or have given birth within the last 6 months?
Have you had a recent surgery?
Are you currently on any medications, either prescription or non-prescription, on a regular basis?

If you have answered yes to any of the above questions please let us know more here...

How did you find out about us?*

What do you want to achieve?*

Fuzion Martial Arts Participation Agreement

I, the above-named parent / guardian of the above named am applying for membership to The Fuzion Kickboxing Academy and accept all terms and conditions associated with my membership. I agree to abide by all class rules and regulations. I accept that training in Martial Arts involves reasonable risk of injury and accept that appropriate physical contact is a necessary part of Martial Arts training. I hereby give my consent for the instructor / coach to give the immediate necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities where it would be contrary to my own or my child’s best interest in a doctors professional opinion without any delay to take place. I agree to comply with advice given with reference to the use of Martial Arts for personal protection within the framework of legal guidelines. I agree to pay all scheduled fees on time and understand that any financial commitments I make with regard to train at The Fuzion Martial Arts Academy Chingford must be honoured as agreed in my payment schedule. I agree that it is my duty to cancel my training fees when I wish to stop training. I give consent for appropriate photo / video images to be taken and used as part of the academy advertising / marketing material. I have answered the questions above to the best of my ability and affirm that my physical condition is good and I have no known conditions that would prevent me from participation. I acknowledge that participation is at my own pace and comfort level and that I may discontinue my participation in the sessions at any time. Furthermore, I agree to self-determine my exertion through good judgement and to discontinue any activity that exceeds my personal limitations. I understand that by signing this agreement that I hereby waive and release The Fuzion Martial Arts Academy, its staff, and all relevant employees in any way from liabilities or demands as a result of injury, loss, or adverse health conditions as a result of my participation. I affirm that I have read and understand this document and I wish to start my training.

Todays Date*

Date

Signature*