2023 Class Enrolment Form

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To be completed by the student if over 18 years
OR
A legal parent/guardian of a student under 18 years

Welcome and thank you for choosing Ippon Karate Academy.

Please complete this form to enrol and reserve a place in our 2023 Term 1 classes. This form will guide you through the enrolment process based on the age and belt level of the student.

Student training fees will cover upto two nominated classes held between Monday to Saturday and the classes you choose when completing this form will be the student's enrolled classes. Please record your class choices for future reference as we will only contact you if there is a problem with your enrolment.

Classes have a maximum capcity of permitted enrollments and when a class is deemed 'full', that class will no longer appear on the enrolment form as an available option. Instead, a waiting list for that option will appear.

The time table applicable for this enrolment form, will continue through Semester 1 (Terms 1 & 2) and will be reassessed for Semester 2 (Terms 3 & 4) in May 2023.

ABONDONED MEMBERSHIPS:
Please note that due to our classes having limited places, students who have not enrolled or the member has not made contact to the club by 27th January 2023, the membership will be deemed abandoned and the member will forfeit all fees and tentive reserved places will be released for new enrolments. We urge you to complete this enrolment form as soon as practically possible.
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I am completing this enrolment form as:* This field is required.
A legal parent/guardian of a child student under 18 years
The Student 18 years or older
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What is your email address?* This field is required.
example@example.com
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When will the student be returning to classes?* This field is required.Please scroll & select from the drop down box below
Scroll and Select From Below
Scroll and Select From Below
During January Holiday Time Table: Week beginning 16th Jan
During January Holiday Time Table: Week beginning 23rd Jan
During Beginners Week Time Table: Week beginning 30th Jan
Term 1 Time Table: Week Beginning 6th Feb
Term 1 Time Table: Week Beginning 13th Feb
An alternative date:
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Alternative datePlease select the date below when the student will return to classes
Date
Year
Month
Day
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What age group is this enrolment for?* This field is required.Please select child, teen or adult for the age group for the student you are enrolling
Scroll and Select From Below
Scroll and Select From Below
Child (4 to 13 years)
Teen (14 to 17 years)
Adult (18+)
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Student's Name* This field is required.Please complete student's name
First Name
Last Name
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Parent/Guardian's Name* This field is required.Please complete student's name
First Name
Last Name
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Parent/Guardian's Mobile Number* This field is required.If student is 18 years & over
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Child's Gender* This field is required.
Male
Female
Non Binary
Other/Prefer Not To Say
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What school or kinder/early childhood centre does the student attend?* This field is required.
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Student's Birth Date* This field is required.
Day
Month
Year
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Student's Age* This field is required.From 4 to 13 Years
Scroll and Select From Below
Scroll and Select From Below
4 Years
5 Years
6 Years
7 Years (Turning 8 years on or before 31st March)
7 Years (Turning 8 years on or after 1st April)
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
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Student's Name* This field is required.Please complete student's name
First Name
Last Name
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Parent/Guardian's Name* This field is required.Please complete student's name
First Name
Last Name
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Parent/Guardian's Mobile Number* This field is required.If student is 18 years & over
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Child's Gender* This field is required.
Male
Female
Non Binary
Other/Prefer Not To Say
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What school does the student attend?* This field is required.
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Student's Birth Date* This field is required.
Day
Month
Year
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Student's Age* This field is required.From 14 to 17 Years
Scroll and Select From Below
Scroll and Select From Below
14 Years
15 Years
16 Years
17 Years
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Your Name* This field is required.Please complete student's name
First Name
Last Name
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Your Mobile Number* This field is required.If student is 18 years & over
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Your Gender* This field is required.
Male
Female
Non Binary
Other/Prefer Not To Say
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Age Bracket* This field is required.Please select the bracket your age falls in
Scroll and Select From Below
Scroll and Select From Below
18-29 Years
30-39 Years
40-49 Years
50-59 Years
60+ Years
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What is the student's current rank/grade?* This field is required.
Scroll and Select From Below
Scroll and Select From Below
White
Red/White Stripe (no black tips)
Red/White Stripe + 1 Black Tip
Red/White Stripe + 2 Black Tip
Red/White Stripe + 3 Black Tip
Red
Yellow/White Stripe
Yellow
Orange/White Stripe
Orange
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Little Samurai Beginners - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 5.30pm
Tuesday 4.30pm
Tuesday 6.00pm
Wednesday 5.30pm
Thursday 4.30pm
Friday 6.00pm
Saturday 9.00am
I need to speak to reception regarding my selections
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Little Samurai Beginners - Class Selection 2* This field is required. Memberships include up to two classes per week. Please select your second class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 5.30pm
Tuesday 4.30pm
Tuesday 6.00pm
Wednesday 5.30pm
Thursday 4.30pm
Friday 6.00pm
Saturday 9.00am
I need to speak to reception regarding my selections
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Little Samurai Advanced - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 5.30pm (Advanced)
Tuesday 4.30pm (Advanced)
Tuesday 6.00pm (Advanced)
Wednesday 5.30pm (Combined)
Thursday 4.30pm (Combined)
Friday 6.00pm (Combined)
Saturday 9.00am (Combined)
I need to speak to reception regarding my selections
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Little Samurai Advanced - Class Selection 2* This field is required. Memberships include up to two classes per week. Please select your second class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 5.30pm (Advanced)
Tuesday 4.30pm (Advanced)
Tuesday 6.00pm (Advanced)
Wednesday 5.30pm (Combined)
Thursday 4.30pm (Combined)
Friday 6.00pm (Combined)
Saturday 9.00am (Combined)
I need to speak to reception regarding my selections
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What is the student's current rank/grade?* This field is required.
Scroll and Select From Below
Scroll and Select From Below
White
Red/White Stripe
Red
Yellow/White Stripe
Yellow
Orange/White Stripe
Orange
Green/White Stripe
Green
Blue/White Stripe
Blue
Purple/White Stripe
Purple
Brown/White Stripe
Brown
Black/White Stripe
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Junior Novice - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 6.15pm
Tuesday 5.15pm
Wednesday 6.15pm
Thursday 5.15pm
Friday 6.45pm
Saturday 9.45am
I need to speak to reception regarding my selections
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Junior Novice - Class Selection 2* This field is required. Memberships include up to two classes per week. Please select your second class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 6.15pm
Tuesday 5.15pm
Wednesday 6.15pm
Thursday 5.15pm
Friday 6.45pm
Saturday 9.45am
I need to speak to reception regarding my selections
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Junior Intermediate - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 7.00pm
Tuesday 6.45pm
Wednesday 7.00pm
Thursday 6.00pm
Friday 5.15pm
Saturday 10.30am
I need to speak to reception regarding my selections
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Junior Intermediate - Class Selection 2* This field is required. Memberships include up to two classes per week. Please select your second class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 7.00pm
Tuesday 6.45pm
Wednesday 7.00pm
Thursday 6.00pm
Friday 5.15pm
Saturday 10.30am
I need to speak to reception regarding my selections
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Junior Advanced - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 7.00pm
Tuesday 6.45pm
Wednesday 7.00pm
Thursday 6.00pm
Friday 5.15pm
Saturday 10.30am
I need to speak to reception regarding my selections
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Junior Advanced - Class Selection 2* This field is required. Memberships include up to two classes per week. Please select your second class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 7.00pm
Tuesday 6.45pm
Wednesday 7.00pm
Thursday 6.00pm
Friday 5.15pm
Saturday 10.30am
I need to speak to reception regarding my selections
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Junior Senior - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Tuesday 7.30pm
Thursday 7.30pm
Friday 5.15pm
Saturday 10.30am
I need to speak to reception regarding my selections
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Junior Senior - Class Selection 2* This field is required. Memberships include up to two classes per week. Please select your second class selection for the student beginning from Term 1. *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Tuesday 7.30pm
Thursday 7.30pm
Friday 5.15pm
Saturday 10.30am
I need to speak to reception regarding my selections
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Junior Squad Class This year we will be holding a squad class for Junior students. This class will run every week alternating between kata squad and kumite squad. These classes will be an additional class to the regular two classes per week and not a replacement class. Squad classes will be offered to students by invitation and are structured to support students who are interested in competing at tournaments. For those students wanting to take their karate to the next level, our club also has the opportunity through the Shitoryu Shukokai Union Oceania to compete in Japan at the end of the year. These squad classes would be a part of the preparation for this tournament. When: Thursday nights at 6.45pm This class will be at no addition cost to membership fees although there will be the cost of protective equipment for kumite squad participants and tournament fees. If you would like your child to be considered for an invitation to the squad training classes, please register below.
My child is interested in (Scroll and Select From Below )
My child is interested in (Scroll and Select From Below )
kata squad training
kumite squad training
kata & kumite squad training
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What is the student's current rank/grade?* This field is required.
Scroll and Select From Below
Scroll and Select From Below
I am a returning student (have not trained for 12 months or longer)
White
Red/White Stripe
Red
Yellow/White Stripe
Yellow
Orange/White Stripe
Orange
Green/White Stripe
Green
Blue/White Stripe
Blue
Purple/White Stripe
Purple
Brown/White Stripe
Brown
Black/White Stripe
Black
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What is the student's current rank/grade?* This field is required.
Scroll and Select From Below
Scroll and Select From Below
I am a returning student (have not trained for 12 months or longer)
White
Red
Yellow
Orange
Green
Blue
Purple
Brown/White Stripe
Brown
Black/White Stripe
Black
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Teen & Adult Novice/Intermediates - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. Adult classes are 1 hour *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Monday 7.45pm
Wednesday 7.45pm
Saturday 11.15am
I need to speak to reception regarding my selections
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Teen & Adult Novice/Intermediates - Class Selection 2* This field is required.Memberships include up to two classes per week.
Scroll and Select From Below
Scroll and Select From Below
Monday 7.45pm
Wednesday 7.45pm
Saturday 11.15am
I need to speak to reception regarding my selections
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Teen & Adult Seniors - Class Selection 1* This field is required.Please select your first class selection for the student beginning from Term 1. Adult classes are 1 hour *Don't forget to record you selection for future reference
Scroll and Select From Below
Scroll and Select From Below
Tuesday 7.30pm
Thursday 7.30pm
Saturday 11.15am
I need to speak to reception regarding my selections
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Teen & Adult Seniors - Class Selection 2* This field is required.Memberships include up to two classes per week.
Scroll and Select From Below
Scroll and Select From Below
Tuesday 7.30pm
Thursday 7.30pm
Saturday 11.15am
I need to speak to reception regarding my selections
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Alternative Emergency Contact's Name* This field is required.We will contact this person in an emergency for student's over 18 years or students under 18 in which we cannot contact the parent
First Name
Last Name
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Emergency Contact number* This field is required.
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Relationship to student* This field is required.eg: other parent, grand parent, aunt, uncle, friend etc
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Does the student have asthma, or any other medical condition that could be effected by participation?* This field is required.If no conditions, please type 'none'
If yes, please describe and how managed
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Medical Authorisation* This field is required.In the event of an injury or medical emergency, I allow Ippon Karate Academy to provide first aid, arrange transport to a medical facility if required, and authorise emergency treatment as recommended by a doctor for the student named on the enrolment. I understand that all reasonable efforts will be made to contact the student’s parent and/or emergency contacts if an injury or medical emergency occurs. I understand I will be responsible for any costs arising from this.
I understand & agree
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Acknowledgement & Agreement

This Agreement is between {studentsName} (“Student”) and Hunt Family Shukokai Karate Pty Ltd trading as Ippon Karate Academy and its affiliates* (‘IKA’).

By participating in recreational activities conducted by IKA in the capacity of a Student, the Student acknowledges and agrees:

1. IKA is in the business of providing recreational services that relate to Martial Art programs, self defence training and sport karate programs in the capacity of group or private classes, belt assessments/gradings, tournament competition and introductory lessons/come and try days (“Services”).

2. The Student understands the Services offered by IKA include physical contact as part of the Martial Arts training or self defence instruction.

3. By participating in the Services of IKA, there is a risk of death or of suffering personal injury (both physical and psychological) or loss and damage to property (“Harm”) arising from IKA conducting it’s Services. The student voluntarily agrees to assume all of the foregoing risks and accept sole responsibility for any harm.

4. Possible causes of Harm include, but are not limited to: joint and muscle sprains and strains, bruising, concussion, cuts and abrasions, dehydration, dental damage, joint injuries, nose injuries, stress fractures, bone/joint/muscle breakages & strains, serious illness from contagious diseases including but not limited to Coronavirus (COVID-19).

5. The Student releases and forever discharges and indemnifies IKA from all claims that you may have or may have had from or in connection with your participation in Services and holds it harmless with respect to all liability for Harm howsoever arising, except to the extent prohibited by law.

6. The Student voluntarily participates in the Services of IKA at entirely their own risk and understands that Martial Arts is a potentially dangerous activity.

7. The Student will not, whilst on the premises, consume or otherwise take in substances or do things that will adversely affect the Student’s physical or mental ability, capacity or judgement.

8. The Student agrees to abide by all rules and directions of IKA whilst on premises or visiting affiliate locations & events.

9. The Student warrants they are in good health and are not receiving treatment for any illness, disorder or injury and knows of no medical reason which would render it unsafe for them to take part in Services provided by IKA.

10. The Student has disclosed any medical condition/s which may affect the Student’s physical or mental ability, capacity or judgement.

11. The Student understands before any Services are provided, the lead instructor is to be informed of any known changes to their health, including any injuries, illness or any condition/s which may impact their training.

12. The Student understands that under no circumstances shall the information and techniques learnt at IKA be used or taught, unless necessary for self defence and/or IKA sanctioned Services.

13. This agreement shall be governed and construed by the laws of the State of Victoria, Australia. The situs for all actions is Melbourne, State of Victoria, Australia. All provisions of this agreement are intended to be interpreted and construed in a manner to make such provisions valid, legal and enforceable in a court of law.
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Parent/Guardian Agreement* This field is required.To be signed on behalf of Student under the age of 18 years I am the legal parent/guardian of {studentsName} (“Student”) who is under 18 years old. I have read this Acknowledgement & Agreement and understand its contents. I accept the conditions of this agreement and acknowledge the risks arising from participation of recreational Services conducted by IKA. I understand by signing this release on behalf of the Student, I am giving up the same rights for the said Student as if I signed this release on my own behalf. I understand that attendance and participation will be at my &/or my child's own risk and cost.
Clear
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Student (over 18 years) Agreement* This field is required.To be signed by Student over the age of 18 years I am {studentsName} (“Student”) who is over 18 years. I have read this Acknowledgement & Agreement and understand its contents. I accept the conditions of this agreement and acknowledge the risks arising from participation of recreational Services conducted by IKA. I understand that attendance and participation will be at my own risk and cost.
Clear
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Additional Class Information

Student enrolments will be allocated a place in registered classes on a first in/order of received basis.
Any students who do not submit their enrolment prior to classes being at capacity will be offered alternative class time/s.
Students who do not submit enrolments will be offered two class time slots based on the remaining places available at the next session time available.

CHRISTMAS & NEW YEAR:
The last day of classes for 2023 will be Thursday 21st December. The dojo will be closed for three weeks during the festive period. This time is included in the training calendar and fees will still apply unless a suspension form is submitted. Classes will return on Monday 15th January 2023.

EASTER:
Closed - Good Friday, Easter Saturday & Easter Monday. This time will not effect classes in 2023 as it will be worked around the Term 1 School Holiday Program

PUBLIC HOLIDAYS DURING SCHOOL TERMS:
No classes held unless otherwise notified. Make up classes are offered as a replacement for missed classes due to public holidays.

SCHOOL HOLIDAYS:
A school holiday program will operate and the dojo will be open a minimum of two days of classes for each week during the school holidays.

PUBLIC HOLIDAYS DURING SCHOOL HOLIDAYS:
There will be no classes held on January 26th due to Australia Day long weekend. Make up classes can be booked and attended in February.

SPECIAL EVENTS:
From time to time our club and organisation Shitoryu Shukokai Union has special events including gashuku (association group training), public community events, instructor training & gradings, national coaching & referee commitments, student social events & new student programs. When these events take place it can affect the class timetable. Students will be offered an altered time table or make up classes if this effects their allocated class selections.

MISSED CLASSES:
One off missed classes due to personal circumstance, public holidays or special events can be regained by training in other available classes by booking in via SMS 0488 883 656. Please speak to reception for more information.

MEMBERSHIP SUSPENSIONS:
To suspend your membership you can do so by completing the online form at www.ipponkarate.com (Terms & conditions apply)
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