Application for Membership Form
Surname:
_________________
Name:
__________________
Residential
Address; _______________________________________ Post Code: ________
Postal
Address;
___________________________________ Post Code:
Contact
Phone:
Contact
Fax:
Contact
Email Address:
Date
of Birth:
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Prior history and current status of Aikido practice (including rank and dojo, if applicable)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Prior history and current status of other martial arts practice (including rank and dojo, if applicable)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
List any existing physical conditions, including permanent and temporary conditions and injuries.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Person
to advise in the case of emergency:_______________________________________
Contact
details: ___________________________________
_______________________________________________________________________________
Please
read the following carefully:
I recognise that, while all possible care shall be taken to prevent the occurrence of injury, Aikido, being a martial art, could by its nature result in injury or death, or aggravate an existing injury or medical condition.
I agree to maintain a careful and disciplined attitude at all times to minimise the risk of injury. I further agree to advise the Dojo Cho or instructor of any injury or physical condition, existing prior to or arising during my membership, that may compromise my safety or the safety of others.
Should
I sustain any injury during the practice of Aikido, or related activities, no
liabilities shall I attach to any instructor or member of Riai Aikido, or its
affiliated associations.
I have taken up (or hereby waive) my right to consider the rules and objectives of Riai Aikido prior to this application. I hereby undertake to abide by these rules and objectives, and to follow accepted dojo etiquette and the teachings and direction of the instructors at all times throughout the duration of my membership.
I hereby acknowledge that my signature below denotes that I understand the rules, objectives and conditions of my membership and agree to abide by them for the duration of my membership within Riai Aikido.
Signed:
Dated:
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