I, ______(First Name, Surname) Hereby Make Application for Enrolment As a Student of KARATE

KARATEJUTSUCC

APPLICATION FORM

Reg No:2009/125681/23

I, ______(First name, Surname) hereby make application for enrolment as a student of KARATE JUTSU CC

TERMS AND CONDITIONS:

Annual membership fee:

The annual application/membership fee is R320.00 and is due and payable with lodgment of this application. To renew membership, this fee is due and payable, and subject to change.

Tuition fees:

Theentire annual fee is payable in advance, and payable by way of debit order(mark box where applicable)

R______per month (by the 3rd of every month, 12 payments in a full year*)

OR

R______per year (by the first week of tuition, 1 payment per year less 10% discount)

*these fees are due and payable regardless of any absences, whether the student attended any/none of the classes for that month.

I accept that all fees are subject to change by Karate Jutsu CC, taking into account economic factors such as escalation of running costs and inflation.

Take note, that by placing your signature to this document, you demonstrate your acceptance of the Application Form in its entirety.

Take further note, that upon your signature of this document, you hereby bind yourself contractually to Karate Jutsu CC and a legal relationship will immediately commence between you and Karate Jutsu CC. Therefore, should you wish to terminate this legal relationship, you are obligated to give Karate Jutsu CC onemonth’s written notice of such intention to terminate. You are also obligated to pay Karate Jutsu CC monthly tuition fees, until you have provided them with proper notification of termination.

I hereby agree to regard all lessons receivedfrom Karate Jutsu CC as strictly confidential. I undertake that I will not, under any circumstances, divulge the knowledge gained from tuition received, nor will I maliciously and willfully use my knowledge to do unlawful injury to another, but shall abide by the rules of Karate Jutsu CC asregulated by them and conduct myself honorably at all times.

I hereby consent to my suspension and/or expulsion from classes at Karate Jutsu CC, in the event of my breach of any of the above terms, and I will forfeit all fees paid by myself in advance.

I hereby voluntarily accept all risks, loss and/or injuries that I may suffer to myself and/or my property, during the course of my training and tuition with Karate Jutsu CC, whether such injury or loss was acquired on or off the premises of KarateJutsu CC. I hereby totally indemnity Karate Jutsu CC, so that neither the principals nor the instructors, or anyone involved in my training and tuition are legal liable for any such injury, damage or loss.

PERSONAL DETAILS:(write in block capitals)Dojo: ______

Student’s name:______Birth date:______

Home Tel:______Work Tel: ______Cell: ______

E-mail: ______

Postal Address: ______

Name of Guardian/Parent: (If applicant is under 21yrs) ______

Signature: (Guardian or parent is if applicant is under 21 yrs)

Date: ______X______