Name *

First Name

Last Name

Parent Name

Only required for under 18 years.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

Please note MM/DD/YYYY format.

MM

DD

YYYY

Are you prescribed drugs which may impair reaction time or judgment? *

Yes

No

Have you suffered any incapacity requiring medical attention in the past 12 months? *

Yes

No

Are you aware of any health problems that you have that, in the interests of your safety, the academy/club should be advised of? *

Yes

No

Do you suffer from asthma or are you anaphylactic? *

Yes

No

Have you studied a Martial Art before? *

Yes

No

Has a medical practitioner, or any other person or entity, or a Martial Arts club ever excluded you from martial arts in the past? *

Yes

No

I hereby certify and decree that all the information contained in the declaration above is true and accurate. By clicking "SEND" on this form I agree to being added to the Kyokushin North Bondi database and Kyokushin Mailchimp mailing list. You will not be spammed, and can unsubscribe at any point. *

I give consent

SOCIAL ACTIVITIES at KARATE BONDI *

We are organising regular social activities for our Karate Families (end-of-year functions, picnics etc.) Please indicate below if you wish to be notified and agree for us to pass on your email address to our social coordinator Deepika Ratnaike.

YES

NO

I fully recognise and understand that participating in martial arts in general, and Kyokushin karate in particular, can be dangerous. *

I Understand

I hereby acknowledge that the fee structure has been understood by me and that I will pay: [1] my affiliation fees for membership to the International Karate Organisation Kyokushinkai-kan (Tokyo, Japan); [2] my dojo membership fees (school children per term, adults & teens per month/quarter/half-yearly/annual in advance); [3] grading fees and event/tournament entry fees from time to time and when applicable. *

I agree

WAIVER *

I have read and understood the WAIVER linked to this form below. If I did not understand this WAIVER and the terms of the Contract, I requested an independent person to explain it to me. I will follow the dojo rules, etiquette and principles as laid out by Kyokushin Karate North Bondi at all times, and conduct myself accordingly. By clicking "SEND" on this form, I acknowledge the terms of the WAIVER.

Understood