Health Declaration /

Disclaimer Form

Please fill out the following form
in order to participate in our activity.

First Name

Last Name

Date of Birth

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

I HEREBY CONSENT to the student’s use of the training facilities and participation in the martial arts styles offered and in turn agree to the terms and conditions below which I have read and understood prior to the student signing this agreement and my signing of this consent and discharge form. I AGREE to be liable for and INDEMNIFY the Organisation, instructor and fellow students against any damage (as defined within) suffered or incurred by the Organisation, instructors or fellow students as a result of any action or failure to act, and any behaviour whether negligent or otherwise of the Student and whether caused by the Students breach of any term and conditions above appearing or the rules and regulations of the Organisation, instructor or fellow students. 1. In CONSIDERATION of the Organisation permitting me to train and to study in the martial art style I agree as follows: I understand that participating in a martial art style is DANGEROUS and I voluntarily ACCEPT the risk of damage consequent upon or arising from my participation as a student or instructor, and the use of the organisations or instructors facilities.

Thanks for submitting!

Health Declaration / Disclaimer Form

Health Declaration /

Disclaimer Form