World Taekwondo Mandeville

World Taekwondo Mandeville

Member Registration Form
Student Photo upload here*

Browse Files

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Student Information
Student's Name*

First NameLast Name
Birth date*

DayMonthYear
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityParish

Postal / Zip CodeCountry
Have you taken Martial Arts before?
Current level

White belt (beginner)Coloured beltBlack beltNoOther
Date

MonthDayYear
Date
Parent/Guardian Information (if student is under 18)
Name*

First NameLast Name
Mobile Number*

eg 021Phone Number
E-mail*
example@example.com
Alternative Emergency Contact
Emergency Contact's Name*

First NameLast Name
Mobile Number*

eg 021Phone Number
Does the athlete have any medical history or condition that could affect his/her ability to participate in combat sports? If yes, please describe below. *
Payment option

Cash - please make payment at beginning of class
Acknowledgement

I understand that all sports carry a risk of injury and that World Taekwondo Mandeville is not responsible for injuries or loss suffered as the result of participating in these activities.

N.B. There has never been any past incidents/accidents, but is legally required for the liability waiver.

From time to time World Taekwondo Mandeville will post photographs of our athletes, coaches, and supporters online. I will let World Taekwondo Mandeville know by email if I do not consent to my or my child’s photos being shared.

World Taekwondo Mandeville will give 30 days written notice of any fee increase.
Where did you hear about us?*

A friend or colleagueOnline Search (Google, etc...)Local activities listingSocial MediaNews articlesOther
Medical Authorization

In the event of an injury or medical emergency, I allow World Taekwondo Mandeville to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above.

I understand that all reasonable efforts will be made to contact the athlete’s parent and/or emergency contact if an injury or medical emergency occurs.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

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