Goju Ryu Karate and Kobudo Association Aotearoa Membership Registration Form

Goju Ryu Karate and Kobudo Association Aotearoa Application for Membership/Registration

Please complete the form below to sign up. Red asterisk (*) means required information.
MEMBERSHIP OPTIONS. Please choose the one relevant to the person who is wanting to join*
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Junior (7 to 14 yrs)$70.00NZD
Per school term, unless part of a whanau membership

Junior Adults/Tertiary Students (15 to 19years)$80.00NZD
Per school term, unless part of a whanau membership

Unwaged Adult (20+ years)$35.00NZD
Per month, unless part of whanau membership

Waged Adult (20+ years)$45.00NZD
Per month, unless part of a whanau membership

Community Services Card/Gold Card Holder $30.00NZD
Per month, unless part of a whanau membership

Whanau Rates$100.00NZD
2 x child and/or student, per term

Whanau Rates$100.00NZD
1 adult and 1 child/student, per term

Whanau Rates$150.00NZD
2 adults and 1 child/student per term

Add another child/student onto whanau rate option$10.00NZD
Per child/student
About You

Please add the names of those who are joining from your whanau
Name of Registering student/students*
Parent or Legal Guardian (If under 15 years)

First NameLast Name
Parent or Legal Guardian (if under 15 years)

First NameLast Name
Phone Number:*

Area CodePhone Number
Phone Number:

Area CodePhone Number
Emergency Contact One*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Two

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
E-mail (for club newsletters and invoicing)*
Address:*

Street Address

Street Address Line 2

City

Postal address if different from above
Address:

Street Address

Street Address Line 2

City

Postal address if different from above
Please tell us a little bit about why you want to participate in Karate and what you hope to achieve.
Previous Karate Experience
YesNo
YesNo
If so, what is the name and location of your dojo?
YesNo
If you have trained before, or still train, what rank are/were you?
Medical History or Health Conditions
NoYes (Please enter details)
NoYes (Please enter details)
Please ensure these are brought to every session and if there is any other information we need to know, please talk to us about this.
NoYes (Please enter details)
Please ensure that any allergic medication is brought to each class. We do not provide this. If you need help with administering this, please talk to us when you sign up.
NoYes (Please enter details)
Please always tell an instructor of any new injuries and if your in a training situation with an opponent or partner, please let them know also and adapt accordingly.
Disabilities and Accessibility considerations
NoYes (Please enter details)
Please let us know how we can be of assistance to help you engage to your full potential in class. If you have accessibility needs, please let us know also.
Other Information

The following information is not compulsory but helps us with making your experience with training better, and helps us to also consider future funding options to support the club.
FemaleMaleNon-BinaryA gender not listed herePrefer not to say
Do you have a preferred pronoun and or name?
Please tell us your ethnicity/ethnicities and any iwi connections you may have.
If you have any other family/whanau/aiga training at the dojo, please let us know.
Privacy Information
YesNo
Please provide details of the above if you wish. If you do not give permission, we will blur out yourself or your child from any images or videos.
I understand that the dojo will never share my contact information for commercial purposes. I may, however, be contacted by the club managers about club announcements and information relevant to club membership.
And one last question
A Friend or colleagueOnline Search (Google, Bing, Yahoo)Martial Arts WebsiteLocal Activities ListingNews ArticleOther
Membership Rules and Etiquette

The following are generally standard rules and etiquette within any dojo.
Safety

Never leave the mat or the dojo without receiving permission from the instructor.

No food, drink or chewing of gum are allowed on the mat.

Report all injuries to the instructor immediately. When arriving at class with an injury, the instructor must be notified prior to the start of class.

Never come to class under the influence of drugs or alcohol.

Finger and toenails are to be kept clean and trimmed to a reasonable length to prevent injuries to training partners.

No jewelery may be worn during class unless specifically approved by the instructor.

Please keep hair tied back.

Preferably only white top or a rache to be worn under your gi.

No practicing of Karate skills or new techniques is allowed on anyone outside of the dojo. This includes techniques you learned on the internet, saw during a competition, or on a video.

Bullying is not tolerated in or out of the dojo.

At the end of class, it is expected that parents/caregivers come inside to pick their children up. Please communicate regularly with us about pick up routines, so we can ensure safety of children after leaving classes with us.

Tidyness and Hygiene

Everyone in the dojo is responsible for cleaning the dojo both before and after use. This includes the bathrooms and any other spaces we utilise.

Members are to keep their gi clean and in good repair.

Before coming to class, please ensure you are clean.

Bring a Mask to class

Etiquette

Different types of etiquette will become part of the regular training. Understanding these and following these will be important.
I have read, understood, and accept the rules for membership. I have talked these through with my child/ren ( if relevant) who also understands these rules.
Terms and Conditions

Please read the terms and conditions below, and check the box once you have done so.
This membership application will be reviewed by our Membership Committee and is subject to refusal or cancellation, without notice, by us for any reason.

During your training with us, our instructors will always endeavor to provide you and your children with the highest levels of professional instruction and encouragement.

Your signature on this membership application form provides our instructors with your acknowledgment that Goju Ryu Karate & Kobudo is a form of Martial Art and that you accept that there are risks associated with your participation or that of your child.

With this understanding, you indemnify Goju Ryu Karate & Kobudo Association Aotearoa and its instructors from any liability both professionally and/or personally should you/your child sustain any injury as a result of participation in training during the period of membership.

During your training with us it is important to us that you keep us informed of any changes to your membership details or changes to your circumstances that may prevent you from being able to train.

Goju Ryu Karate and Kobudo Association Aotearoa does not require members to sign a contract for an extended period of time, and members may cancel at any time by notifying the Instructor.

It is also important that you keep up to date with your fee payment and if for any reason you have trouble in maintaining your training and/or fee payments, please contact our Instructor Te Awa Puketapu Sensei who will work with you to organise an arrangement that will assist you.

Your gi, belts and weaponary, grading fees, protective and training gear, tourament fees or any other event fees are not included in the membership fee. These are additional payments.

In joining Goju Ryu Karate & Kobudo Association Aotearoa, you agree to continue to pay your training fees each term even when away from training. Payments are per school term and in full or as arranged with the club. Fees will not be refunded where membership is cancelled mid-term.

Fees can be paid directly into the club's account using your name as reference.

Yamabushi Dojo

38-9012-0179010-00

Contact Numbers:

Te Awa Puketapu Sensei 021 157 1516

Peter Rostedt Sensei 0210597966
I certify that I have read and understand the information as contained in the enclosed membership application forms and seek membership with Goju Ryu Karate & Kobudo Association Aotearoa.
We have a lot of students, so to help us with being able to identify who the students are, please upload a pic of the person/persons who are joining.*

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Signature of Member or Legal Guardian*

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Nga mihi kia koe
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Goju Ryu Karate and Kobudo Association Aotearoa Application for Membership/Registration

About You

Previous Karate Experience

Medical History or Health Conditions

Disabilities and Accessibility considerations

Other Information

Privacy Information

And one last question

Membership Rules and Etiquette

Terms and Conditions

Nga mihi kia koe