Sign Up & Waiver

The Academy - Members Waiver

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Date

DD slash MM slash YYYY

Select Class*

Select Coach (if known)

Student / Client Details

If you are of sound mind & body & do not want to consult your GP before commencing training then please read through the agreement below to ensure you are happy to proceed If you have any questions or queries then please feel free to discuss with any of the instructors.

Title*

Name*

First Last

Sex*

Male

Female

Date of birth*

DD slash MM slash YYYY

Age (Years)*

Postal Address*

PO Box Number District ZIP / Postal Code Country

Physical (Home) Address*

Street Address District ZIP / Postal Code Country

Mobile Phone

Home Phone

Work Phone

Emergency Contact Name*

Emergency Contact Phone*

I/My Son/Daughter requires/Is not allowed specific foods-

Does your Son/Daughter have any learning difficulties or behavioural problems (e.g. ADHD/ADD) that we should be aware of?

Student / Client Health history

Please read the following questions carefully and answer each one. We recommend that you seek medical advice prior to participation of any exercise. Do you have or have you ever experienced any of the following:

Joint problems?*

Yes

Back complaints?*

Yes

Epilepsy?*

Yes

High Cholesterol?*

Yes

Food allergy?*

Yes

Currently on medication?*

Yes

Significant illness or an operation?*

Yes

Heart problems?*

Yes

Chest pain?*

Yes

Low blood pressure?*

Yes

High blood pressure?*

Yes

Breathing difficulties?*

Yes

Asthma?*

Yes

Diabetes?*

Yes

Fainting spells?*

Yes

Medical history

Please specify any medical ailments or restrictions you/your child may have and any other relevant information you feel is important (Any activities they are not allowed to do?)

COVID-19 (SARS-CoV-2)

The Academy continues to follow and maintain Government guidelines on the managing the spread of COVID-19. Under current guidelines vaccination are not required for those under 14 years of age. We respect everyone’s rights and preferences to choose what is right by them. We do however ask that If you/your child has any flu like symptoms then please do not attend classes or use the facility.

Vaccination status

Check all that apply

First dose

Second dose

Booster

Exempt

Not vaccinated

Vaccination Record

Please upload a copy of the vaccination record

Max. file size: 256 MB.

Terms & Conditions

Fitness & Health - If you/your child have a pre-existing medical condition you are strongly advised to seek your medical practitioner’s advice before your first training session. If you/your child have a pre-existing medical condition you must make the trainer aware of it. You accept responsibility for your state of health and physical condition. Punctuality & Safety. Please make adequate travel arrangements and time allowance for each training session to ensure that you arrive on time. Please arrive 10 minutes prior to the start of the class. If you are late for whatever reason, your session will start without you and/or you will forfeit the time. You must comply with the safety regulations and instructions of the instructor at all times. Acknowledgment of Risks, Injury & Obligations Your behavior whilst participating shall not constitute a security or safety hazard to yourself or others. You hereby acknowledge that the activity you are to undertake is a dangerous activity and that by participating in it you are exposed to certain risks. You acknowledge and understand that whilst participating in such activity you may be injured, physically or mentally, or may die; your personal property may be lost or damaged; other persons participating in such activity may cause you injury or may damage your property; you may cause injury to other persons or damage their property; the conditions in which the activity is conducted may vary without warning; there may be no or inadequate facilities for treatment or transport of you if you are injured; and you assume the risk of and responsibility for any injury, death or property damage resulting from your participation in the activity. Release and Indemnity You hereby accept that you participate in the activity at your sole risk and responsibility. You release, indemnify and hold harmless Mind Body Life Fitness Training LTD from and against all and any actions or claims which may be made by you or on your behalf or by other parties for or in respect of or arising out of any injury, loss, damage or death caused to you or your property whether by negligence, breach of contract or in any way whatsoever. You agree that in the event that you are injured or your personal property is damaged, you will bring no claim, legal or otherwise, against Mind Body Life in respect of that injury or damage. Administration Fees are not refundable or transferable. Prices are liable to change from time to time. Agreement By signing this document, I confirm that I have read and understood the above Membership Terms and Conditions as defined above and I know that they affect my legal rights. I agree to abide by the rules enshrined in these Membership Terms and Conditions.

I am aware and understand that the nature of martial arts/ jiu-jitsu will generally require close physical contact with other students & Instructors, both male and female.*

Yes

Whilst I am aware that the utmost effort & measures are taken to minimize any potential exposure to Covid 19, I/my child will be partaking in a contact martial art/sport and hereby do give permission for him/her to participate.*

Yes

I am aware that if I cancel my session without giving 24 hours notice that I will, at the discretion of the Instructor, lose that session & forfeit the fee allocated for that hour*

Yes

I have read the information pack & waiver and understand that after completing registration that I will not be issued a refund unless exceptional circumstances dictate otherwise (Injury, bereavement, emergency) and that if i/my child misses classes, they cannot be carried over. I will give a minimum of 24 hours’ notice to cancel/reschedule my/my child’s session or forfeit that class*

Yes

I am aware that I must complete my induction/ training package in the time agreed with my trainer/coach*

Yes

Consent*

I confirm that the above information is true and complete to the best of my knowledge and I accept the terms and conditions of the agreement as outlined above.

Your Name*

First Last

How did you hear about us?

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Social media

Friend

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Other

Signature*

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Sign Up & Waiver

The Academy - Members Waiver

Student / Client Details

Student / Client Health history

COVID-19 (SARS-CoV-2)

Terms & Conditions

coaches

combat arts

health