MEMBERSHIP - JUDO KENKYU NAMBOUR

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APPLICATION, INDEMNITY & CONSENT FORM – PLEASE READ CAREFULLY

I hereby apply to become a member of Judo Kenkyu; to undertake judo training to the best of my ability;
to abide by all safety requirements and code of behavior; to maintain the honor and integrity of judo and to
respect my coaches and fellow judoka. I understand that I am responsible for mat fees which are payable
according to fee policies and at the prescribed rate; compulsory Judo Federation of Australia membership fees
which includes member insurance to the extent of the respective insurance policy; to ensure that I am up to date
with all fees payable annually or on a pro-rata basis if applicable as well as grading fees or special event fees from
time to time. I warrant that I am physically and mentally sound to exercise and train in judo and that I understand
the associated risks in doing so.

Name *FirstLastGender *Date of Birth *Date of Application *Residential Address *Contact Number *Emergency Contact Number *Email *Do you have any medical conditions that may limit your judo training? *

IF YOU ANSWERED YES TO THE ABOVE QUESTION, THEN PLEASE EXPLAIN THE NATURE OF THE CONDITION OR INJURY, AND IF SPECIAL CONSIDERATION IS NEEDED WHEN TRAINING OR COMPETING IN JUDO :SignatureCONSENT: I UNDERSTAND THAT JUDO IS A CONTACT SPORT WHETHER TRAINING OR COMPETITION OR BEING
PRESENT AT JUDO ACTIVITIES, AND AS SUCH CARRIES A RISK OF INJURY. I HERBY AUTHORISE ANY OFFICIAL FROM
JUDO KENKYU OR AFFILIATE ASSOCIATION IN THE EVENT OF ANY INJURY OR ILLNESS TO OBTAIN ON MY
BEHALF AND AT MY EXPENSE ANY MEDICAL ASSISTANCE, TREATMENT AND TRANSPORTATION AS DEEMED
NECESSARY.
UNLESS I SPECIFICALLY REQUESTED TO THE CONTRARY, I CONSENT TO ANY IMAGES OF MYSELF BEING USED BY
JUDO KENKYU FOR THE SOLE PURPOSES OF PROMOTION, ADVERTISING, TRAINING AND EDUCATION IN
JUDO.
INDEMNITY: I AGREE THAT JUDO KENKYU, ITS BUSINESS OWNERS, DIRECTORS, OFFICERS, MEMBERS,
SERVANTS OR AGENTS ARE ABSOLVED FROM ALL LIABILITY, INDEMNIFIED AND HELD HARMLESS AGAINST ALL
CLAIMS HOWEVER ARISING FROM INJURY OR DAMAGE TO ME, HOWEVER CAUSED WHILST PARTICIPATING IN OR
BEING PRESENT AT ANY JUDO ACTIVITIES. THIS RELEASE AGREEMENT SHALL BE EFFECTIVE AND BINDING UPON
MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES.
IN SIGNING THIS APPLICATION, I WARRANT THAT ALL INFORMATION PROVIDED IS TRUE AND CORRECT. I HAVE
CAREFULLY READ THE APPLICATION AND UNDERSTAND THE TERMS AND CONDITIONS HEREOF WHICH SERVE AS
A RELEASE AND ASSUMPTION OF RISK, AND THAT BEING AT LEAST 18 YEARS OF AGE AND FULLY COMPETENT, I
HEREBY VOLUNTARILY SIGN IT. Please tick all the boxes to accept the conditions of this Application *

I have read, understand and accept the Terms & Conditions as outlined above
I warrant that all information provided by me is true & correct
Third Choice

Multiple Items

Junior
Second Item
Third Item