Tenchi

Bogyo Ryu
Date of Birth .

Club membership Application / Renewal Form

Name

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Address ............. ..
Post Code Tel No ..

Occupation Emergency contact Email Club Grade . . Mobile No .. Instructor Date Grade Awared

(5th Kyu etc. Leave Blank if Beginner)

Previous martial arts experience

Medical Details
It is vital for your own safety that any relevant medical conditions are disclosed to your coach. ( For example: Asthma, Epilepsy, Heart Disorders, etc.) .. If you do not wish to enter these details on this form, Please discuss any medical condition with your coach

Note To All Prospective Students

Aikido is a Martial Art. Students are warned that there is always a possibility of personal injury, no matter how controlled the class. It is the students responsibility to ensure that their insurance is current prior to any training as failure to hold a current valid insurance License could jeopardise any insurance claims.

Data Procection Act

It is a requiremnet of the data protection act 1998 that persons give their written authorisation to have their details recorded. By signing below, you are allowing your personal details to be recorded in Tench Bogyo Ryu database. These database are not distributed to any other third party and are not used for non Aikido related functions. Also we need Your permission to be photographed for publicity purposes. Pictures will be issued to newspapers, magazines, club websites etc. For those persons under the age of 16 (sixteen) please ensure a parent or legal guardian signs on your behalf. Signed Date .. (To be signed by guardian if under 16. )

Students Declaration
I accept that neither the Instructor nor Club or any other organizations involved can be held liable for any injury, which occurs during a properly supervised class. On joining the Aikido Tenchi Bogyo Ryu Club, I agree to accept the Club's rules and accept that the practice of Aikido involves the risk of injury. Signed Date .. (To be signed by guardian if under 16.)

For Official Use Only Date Received ..

Expiry Date ...