Kan Zen Ryu Karate-Do

Farrelly Dojo's

Membership Application Form

I, the below, request to apply to join as a paying member, the Kan Zen Ryu Karate, (Farrelly Dojo's) Karate Club.

1. Release Form

I hereby release Kan Zen Ryu Karate, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind in relation to all terms and conditions stated below.  The completion of this form below is an acknowledge to the agreement of all terms and conditions and I acknowledge I have read and fully understood the terms of the Martial Arts Contract, or if I did not understand the terms of the Contract, I requested an independent person to explain them to me.

Declaration of Understanding

Martial Arts Is Dangerous

I understand and accept that it is my responsibility to:
a. Inform the Instructor/s of existing medical conditions (eg. asthma, epilepsy, etc.) that may affect my ability to train.
b. Consult a doctor to ensure that training in Martial Arts will not be detrimental to my health.
c. Take necessary precautions, and/or medication as prescribed (eg. asthmatics must bring puffer to class).
d. Inform the Instructor/s and training partners (prior to training) of any injuries that may be aggravated by certain movements.
I declare that the details I have provided on this form are correct. I understand and accept that these details may be available to Kan Zen Ryu Karate, Committee Members & Instructors, and Kan Zen Ryu Karate staff.   My details may not otherwise be released without my permission.

Media Consent & Release - Videography & Photography 
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of myself and the recording of my voice and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage.
I further consent to the reproduction and/or authorization by Kan Zen Ryu Karate to reproduce and use said photographs and/or recordings of my voice, for use in all domestic and foreign markets.
I hereby release Kan Zen Ryu Karate, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use.

Martial Arts Training

The providers agree to permit me to use their premises and facilities for Martial Arts, to instruct me in Martial Arts and related activities ("the service") upon and subject to the following terms and conditions:

(a) Club Fees
The Applicant will pay on demand or by mutual consent the prescribed or stated fees for the service. Such fees may be notified to the Applicant by letter or memorandum or by notice displayed in the provider's premises or premises occupied by the provider, electronically via email or verbally.
(b) Medical Conditions
The Applicant warrants that he or she has not at any time suffered any blackout, seizure, convulsion, fainting or dizzy spells and is not presently receiving treatment for any illness, disorder or injury which would render it unsafe for the applicant to take part in Martial Arts training. The applicant further warrants that he/she has provided information on any and all pre-existing medical conditions.
(c) Exclusion of Applicant
The Applicant warrants that he or she has not at any time been excluded from Martial Arts by a medical practitioner or any person or entity including a Martial Arts Club.
(d) Rights of a Consumer
If the Trade Practices Act 1974 or similar state laws apply to this agreement then certain terms and rights may be implied into this contract which operates for the benefit of the Applicant. Under the provision of that legislation, those terms and rights, and any liability of the supplier flowing from them, cannot be excluded, restricted or modified by any provision of the contract.

PLEASE NOTE THE FOLLOWING:
If the Trade Practices Act 1974 or similar state laws operates so as to prevent the exclusion, restriction or modification of warranties otherwise implied by those laws then the liability of the offerer for breach of those warranties is limited to:
(i) the re-supply of the Martial Arts instruction and related activities; or
(ii) the payment of the cost of having the Martial Arts and related activities supplied again.

(e) Waiver and Indemnity
In all other cases and except where inconsistent with the above, the Applicant for him/herself, his/her executors,
administrators, dependents and other personal representatives, hereby absolves and indemnifies the providers and all their servants, agents, employees and other students or persons under the providers control (the "indemnified") from all liability howsoever arising for injury or damage (including but not limited to the Applicants' person, whether fatal or otherwise, property and personal belongings) however caused including by the negligence of the indemnified, arising out of or participating in Martial Arts or in connection with Martial Arts or in anyway caused by, or arising out of, any activity carried on by the indemnified.
I, the Applicant, have been advised and understand that the practice of martial arts is potentially dangerous.
I, the Applicant, agree to occupy and use the premises of the Kan Zen Ryu Karate organization at risk to myself and release to full extent permitted by law Kan Zen Ryu Karate, and its agents, servants, contractors and employees from all claims and demands of every kind in of or resulting from any accident or damage to property or injury or death to myself while undertaking training in martial arts with the Kan Zen Ryu Karate Club.
(f) Martial Arts done at Applicant's own Risk
Any person training in Martial Arts, or in activities connected with Martial Arts or participating in any activity carried on by the Kan Zen Ryu Karate Club are only allowed to do so on the distinct understanding that they do so entirely at their own risk.
(g) Martial Arts not to be taught by Applicant
The Applicant agrees that he/she is in no way qualified or authorised to teach any Kan Zen Ryu Karate martial arts styles publicly or privately in any way whatsoever for personal, monetary or any form of gain whatsoever unless with the written authorisation of the Chief Instructor, (Tyraus Farrelly), of the Kan Zen Ryu Karate, Figtree Dojo .

(h) Agreement to abide by the Organisations Rules
I, the Applicant, agree that I will abide by the Kan Zen Ryu Karate Club Code of Conduct and Safety Regulations, and agree and acknowledge that any failure to abide by rules of the Code of Conduct and Safety Regulations may result in my expulsion from the Kan Zen Ryu Karate Club with no refund of fees.
(i) Acceptance Performance of the provider's obligations under the contract may be affected by any one or more of the providers either jointly or severally.
(j) Governing Law
Any agreement entered into pursuant to this acceptance is to be governed by the laws of the State of New South Wales and the Courts of the Commonwealth of Australia shall have exclusive jurisdiction to entertain any action in respect of any such agreement.
(k) Statement of Understanding
I, the Applicant have read, or have had read to me the above conditions and having understood the same, I consent to the activities proposed.

First name:
Last name:
E-mail:
Address:
Suburb:
State:
Post Code:
Date of Birth:
Age:
Gender:
Phone:
Mobile No.:
If Under 18 - I have a Parent/Guardian's Consent :
Parent/Guardian Full Name, (If under 18):
Parent/Guardian's Email, (If under 18):
Emergency Contact No.:
I am medically fit to train in karate:
List Relevant Medical Conditions:
Medications:
Class Type:
Classes Attending Per Week:
Payment Type:
How Did You Hear About Us:
Previous Style(s):
Grade Achieved:
I agree to all terms & conditions above: