Branch Membership

MEMBERSHIP

2023 Branch Membership Application
NB: This form is for club membership and solely for details to be included within our online mailing and invoice systems.

* Indicates required field

Student Full Name *

JKAA Membership Number (4 digit number) *

Current Belt Colour *

Medical Conditions - please list any medical conditions/allergies pertaining to the student. If not applicable please type NONE. *

Parent/Guardian Full Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Number *

Email (invoices will be sent to this address) *

Gender *

Male Female

Student Age *

Student Date of Birth *

Student Nationality *

Enrolled Class *

4.30-5.15pm Class 1 (Yellow-Green) 5.15-6.00pm Class 2 (Beginners) 6.00-7.30pm Class 3

Disclaimer/Form of Release and Student Awareness:
Applicant Declaration:

My Child is medically fit to participate in a strict Karate training programme and I am aware that there are strenuous training exercises involved in this discipline. Whilst all the safety rules and regulations will be strictly enforced in the Dojo, I am reminded that Karate is a high risk contact sport, and as a consequence of membership I accept that I may sustain accidental and serious injury during KARATE related training. This will include in or around the designated area of the Dojo, during arranged competition, grading examinations and any promotional demonstrations or training out with the Dojo training times.

Furthermore, because Karate is a contact sport, I understand that the JKAA representative Sensei ROY and Sensei MARIE, instructors, officials, students and guests will not be held responsible in any way in the event of any accidental injury, fatality during training, or theft of personal belongings. I affirm that I will participate in all of the aforementioned activities at my own risk. I am aware that all vehicles are parked at the owner’s risk.

I understand that after my initial trial period I am required to officially register with JKAA on an annual basis which requires a membership application payment of $75 to be paid. I know that all costs involved with JKAA membership may be subject to annual increase.

I will pay all related training fee costs ON TIME and I am aware that penalties apply for late and outstanding payments. I understand that my application for membership requires approval and has to be registered with JKAA main office before full membership & insurance cover can commence. Late payment of tuition fees will result in training being refused for insurance purposes. I agree to provide sufficient notice for termination of membership and am aware without this full payment of invoices will be required.

I understand it is my responsibility to read all relevant information sent via email or posted on our closed parents Facebook page on a regular basis to keep up to date with details and events relating to tuition and activities within JKA Bribie Island.

I agree to JKA Bribie Island having full permission to photograph my child/children or myself and understand that pictures may be used for publicity purposes including but not limited to brochures, advertisements, social media and JKA websites. Families may opt out by emailing the school at any time.

“I promise to uphold the true spirit of Karate - Do and will abide by the rules and regulations of the organisation. I am honest and of good character and have no criminal convictions.” Both parties can terminate membership at any time without fear of penalty. The details supplied in this application are confidential, accurate, and truthful, and will only be used for related JKAA purpose.” *

I agree

Submit

MEMBERSHIP

2023 Branch Membership ApplicationNB: This form is for club membership and solely for details to be included within our online mailing and invoice systems.

2023 Branch Membership Application
NB: This form is for club membership and solely for details to be included within our online mailing and invoice systems.