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Ikigai Martial Arts Academy Registration form

All items marked with an * must be filled out.

Members Name.

Parent/Guardians Name (If Member Is Under 18 Years Old).

Phone Number.

Email Address.

Members Date Of Birth

Emergency Contact Name

Emergency Contact Phone Number

Health Information.

Please list any relevant health information regarding the person named on this form, including any neurological conditions that you would like our staff to be aware of. All Health Information will be kept in confidence and helps us to provide suitable training based on your needs. Disclosure of Medical information will only be accessed by authorised staff and will not be shared to third parties without consent unless required by law. Peoples over 18 years of age are encouraged to answer the following questions before participating in any physical activities. If you choose not to disclose any medical conditions that may increase your risk of injury or complication during your participation in any activity, you do so at your own discretion and accept full responsibility for any injury or complications sustained.

Has a medical practitioner ever told you that you have a heart condition or have you ever suffered from a stroke?

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?

Do you ever feel faint, dizzy or lose balance during physical activity/exercise?

Have you had an asthma attack requiring immediate medical attention during the last 12 months?

If you have diabetes (type 1 or 2) have you ever had trouble controlling your blood sugar (glucose) in the last 3 months?

Do you have any other conditions that may require special consideration for your exercise?

If you answered 'Yes' to any of these questions please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking any physical activity.

Membership Level.

No charges will apply for weeks you are entirely unable to attend. Please be advised that the weekly fee associated with your selected package will be charged regardless of your ability to attend multiple classes or any included private training during any given week.
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Please Select A Membership Level.

What Type Of Classes Will You Be Attending?

Private and Small Group Training.

Ikigai Martial Arts Academy offers private and small group training sessions. If you are interested please inquire with your instructor.
Schedule one session per week and receive a 50% discount on every fourth session.
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Digital/Physical Media Consent Form.

Please read the following carefully and assure you fully understand before signing.

I hereby grant Xavier Reece Shaun Murphy T/A Ikigai Martial Arts Academy (the Company) permission to use my likeness in photographs, videos, or any other digital or physical media, in any and all of its publications, including web-based publications without payment or other consideration. I hereby understand and agree that all photos, videos, and any other digital or physical media become the property of Xavier Reece Shaun Murphy T/A Ikigai Martial Arts Academy (the Company) and will not be returned. I hereby irrevocably authorise Xavier Reece Shaun Murphy T/A Ikigai Martial Arts Academy (the Company), to edit, alter, copy, publish, distribute or exhibit these photos, videos or any other digital or physical media for any promotional purposes. In addition I waive any right to inspect or approve the finished product wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of this digital or physical media.

Please Sign Here.

Signature

Date

Waiver And Assumption Of Risk.

Please read the following carefully and assure you fully understand before signing.

I, the undersigned, hereby fully waive and release Xavier Reece Shaun Murphy T/A Ikigai Martial Arts Academy (the Company), from any and all claims for personal injury, property damage, or death that may result from my participation in the following physical activities:

Martial Arts training, including but not limited to Karate, Kickboxing, Kobudo and Krav Maga:       

I hereby voluntarily, at my own risk, sign this Waiver and Assumption of Risk in sole consideration of being permitted to use the Company’s facilities or property.

I hereby acknowledge and understand that there are dangers and risks associated with the activities described above, which have been fully explained to me. I hereby agree to abide by all rules, instructions, policies and procedures imposed by the Releasee relating to the use of the facilities or property. By signing this Waiver and Assumption of Risk, I fully assume the dangers and risks, and agree to use my best judgement while engaging in those activities. I further agree to indemnify and hold harmless the Releasee, it’s employees, agents, officers, and anyone else connected to Ikigai Martial Arts Academy (the Company) in anyway from and against any and all liability incurred as a result of or in any manner related to my participation in the activities.

I hereby certify that I am of legal age and competent to execute this Waiver and Assumption of Risk, that in doing so of my own free will and accord, voluntarily and without duress, and that I do so intending to bind myself, my executor, my heirs, and administrators or assigns to the fullest extent.

I have read and understood the foregoing, and acknowledge my consent to the terms of this Waiver and Assumption of Risk by signing this Waiver.

Please Sign Here

Signature

Date