Your Namekarate CLUB REGISTRATIONAND CONSENT AGREEMENT

your nameKARATE CLUB REGISTRATIONAND CONSENT AGREEMENT

______copy to be retained by club

Details of Participant

Name: Date of Birth:

Address:

Telephone E-Mail Address:

Number:

Details of Person to Contact in an Emergency:

Emergency Treatment Consent (Compulsory)

I give permission for my child to participate in the classes and activities run by your name Karate Club. I consent to my child receiving emergency medical treatment, on the understanding that I am contacted as soon as is reasonably possible.

In Loco Parentis Consent (Compulsory)

I give permission for the instructors of the your name Karate Club to act ‘in loco parentis’, i.e. supervise, instruct and interact with my child in my absence.

Self-registration and Release Consent (Optional)

I give permission for my child to register and release themselves at the start and end of each session.

Collection by Third Party (Optional)

I give permission for my child to be collected by the person named below:

Medical Information

Please list any medical conditions, allergies ordisabilities that we should be aware of.

Listany medication needed and ensure participanthas correct medication and equipment e.g.

inhalers with them.

Declaration (Compulsory)

I understand that practicing a martial art and self defence involves physical contact and although every effort is made to ensure a safe training environment, there is an element of risk and injuries can occur. Remember that you are responsible for your partners’ safety when training and it is each student’s responsibility to practice accordingly.

I have read and understood the above and will not hold the instructors or fellow students responsible for any injuries sustained in the course of regular training. Furthermore I will abide by the code of conduct of this club and understand that failure to do so may result in the cancellation of my membership.

Sign & date:

(A parent or guardian must countersign this declaration if you are less than 16 years of age.)

your nameKARATE CLUB REGISTRATIONAND CONSENT AGREEMENT

______copy to be retained by new member

Details of Participant

Name: Date of Birth:

Details of Person to Contact in an Emergency:

Child Protection

Karate England operate a child protection policy. Details are available on the Karate England web site. If you have any concerns or queries, please see a registered instructor.

Emergency Treatment Consent (Compulsory)

I give permission for my child to participate in the classes and activities run by your name Karate Club. I consent to my child receiving emergency medical treatment, on the understanding that I am contacted as soon as is reasonably possible.

In Loco Parentis Consent (Compulsory)

I give permission for the instructors of the your name Karate Club to act ‘in loco parentis’, i.e. supervise, instruct and interact with my child in my absence.

Self-registration and Release Consent (Optional)

I give permission for my child to register and release themselves at the start and end of each session.

Collection by Third Party (Optional)

I give permission for my child to be collected by the person named below:

Medical Information

Please list any medical conditions, allergies ordisabilities that we should be aware of.

Listany medication needed and ensure participant has correct medication and equipment e.g.

inhalers with them.It is my responsibility to update the club of any changes.

Code of Conduct

Everybody registering with your name Karate Club, will be issued with a code of conduct, which contains a set of guidelines for Dojo procedure and etiquette, expected standards of behaviour, and club rules and requirements. The club reserves the right to exclude or refuse admission to any participant from any session or course for unacceptable behaviour.

Declaration (Compulsory)

I have read and understood this Registration and Consent Agreement and will abide by it.

I understand that practicing a martial art and self defence involves physical contact and although every effort is made to ensure a safe training environment, there is an element of risk and injuries can occur. Remember that you are responsible for your partners’ safety when training and it is each student’s responsibility to practice accordingly.

I have read and understood the above and will not hold the instructors or fellow students responsible for any injuries sustained in the course of regular training. Furthermore I will abide by the code of conduct of this club and understand that failure to do so may result in the cancellation of my membership.