PRE-TRAINING REGISTRATION FORM
NEWCASTLE - MAYFIELD WEST
Applicant's Name
*
First Name
Last Name
Applicant's Date of Birth
*
-
Day
-
Month
Year
Date
Applicant's Age:
18 Years or Over
Under 18 years
Contact Email
example@example.com
Contact Phone Number
*
-
Area Code (61 for mobile numbers)
Phone Number (Mobile numbers preferred)
Applicant's Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant's Occupation
If currently studying at school or university, type Student.
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Emergency Contact Details
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
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Martial Arts Resume
How did you hear about our school?
*
Internet Search
Friend’s Recommendation
Public Demonstration
Flyer or Poster
Facebook
Instagram
LinkedIn
Dojo Directory
Other (Not Listed Above)
What are your main reasons for studying martial arts?
*
Health & Fitness
Self Improvement
Self Protection
Fun Hobby
Friendship &/or Comraderie
Tournament Competition
Artistic Self Expression
Martial Arts Philosophy
History, Culture & Tradition
Strategy & Tactics
Other
Have you ever studied a martial art (or combat sport) previously?
*
Yes
No
Please list all martial arts you have studied:
*
What is the highest rank you have received in your previous martial arts study?
*
In which martial art did you receive your highest rank?
*
How long did you study the martial art you received your highest rank in?
*
Have you ever been excluded from a martial arts, social, or sporting club?
*
Yes
No
Was your exclusion from the prior martial arts, social, or sporting club based on any of the following? (Please tick ALL that apply)
*
A breach of the club's official Code of Conduct
Inappropriate language or behaviour towards another member of the club
Behaviour deemed sexist or racist by the club
Dangerous or violent behaviour during training sessions
Dangerous or violent behaviour outside of training sessions
A criminal conviction
None of the above
Other
Please explain how you have addressed the language, behavioural, or conduct issues that caused you to be excluded from a previous martial arts, social, or sporting club; and why we should accept you into our club:
*
Martial arts training (especially with weapons) is a serious endeavour that requires a capacity for sound ethical judgement, and empathetic understanding. Please note that if we decide to accept you into our club, this will be on a probationary or trial basis for a period we will determine and communicate before commencement.
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Health Declaration
Please indicate if you suffer from any of the following physical conditions that may impair your ability to participate fully in, or may be aggravated by, martial arts training:
Recurring Injury
Physical Disability
Chronic Illness
Recent or recurring Muscular Skeletal Problems (such as Arthritis, Tendonitis, etc.)
Sensory Impairments
Other
Physical Health Declaration:
*
If you answered YES to the previous question, please outline the physical disability or impairment, physical health issue, or recurring injury.
Are you registered with the NDIS?
Yes
No
Are you current receiving professional treatment or health support for your condition?
Yes
No
If your physical health issue is on-going, please provide evidence from a medical professional (ie. a doctor's certificate or NDIS plan) that you have clearance to participate in martial arts training, and any conditions that may apply to that participation:
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You will not be permitted to train with us until we sight evidence from a medical professional.
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Mental Health Declaration
1 in 8 people in the world live with some kind of mental health disorder. Please indicate any of the following conditions that you experience on a regular basis, or have received treatment for. (Knowing this will help us tailor our programs where we can).
Anxiety
Depression
Bipolar
Post-Traumatic Stress Disorder (PTSD)
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder (ASD)
Schizophrenia
Other
Are you registered with the NDIS?
Yes
No
Are you currently receiving treatment or professional support for your condition?
Yes
No
Mental Health Declaration:
If you answered YES to the previous question, please outline the mental health issues.
If your mental health issue is on-going, please provide evidence from a medical professional (ie. a doctor's certificate or NDIS plan) that you have clearance to participate in martial arts training, and any conditions that may apply to that participation (ie. including the requirement for the presence of a personal carer):
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Acknowledgement
I, the undersigned, hereby acknowledge that all the information I have provided is true and correct at the time of signing.
Applicant's Signature
*
Date
*
-
Month
-
Day
Year
Date
I received assistance from a parent or legal guardian in completing this form:
*
Yes
No
Parent or Legal Guardian's Name:
*
First Name
Last Name
Contact Phone Number
*
-
Area Code (61 for mobile numbers)
Phone Number (Mobiles preferred)
I, the applicant's parent or legal guardian, have read and understood the Training Contract, and have discussed its contents with the applicant, and am satisfied that the applicant understands and will abide by the conditions set out in the contract.
*
Yes
No
Parent or Legal Guardian's Signature:
*
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: