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Flow State Martial Arts and Fitness Pty Ltd

 
                 MEMBERSHIP APPLICATION

I, the undersigned (or parent) do hereby apply for membership at Flow State Martial Arts and Fitness (here in after called FSMAF) and certify that all the information supplied by me is correct. 

Please read carefully and initial below:        MEMBERSHIP CONDITIONS

 

1.   I acknowledge that Martial Arts training is a contact sport which requires both dynamic and physically demanding exercises and that participation in Martial Arts carries a reasonable risk of injury. 

2.   I certify that I am (or the student hereby represented) is in excellent physical health.   

3.   I understand that the payment for my tuition is to be made as detailed and is not altered or affected by my attendance.  I understand that failure to complete the lessons does not relieve me of my obligation to pay the agreed tuition terms.

4.  I acknowledge that whilst on FSMAF’s premises or any other place where I attend training and during all training times, both my property and my person shall be my own risk and I will not hold the FSMAF or its members liable for any property loss and damage or personal injury.

5.   I understand that additional fees will apply for any late fee instalments or any instalments not able to be collected on the specified date. Also I will be liable for any legal costs associated with recovering late or unpaid fees.  

6.   I understand that the FSMAF reserves the right to terminate my membership at any time, following which I will only be liable for any outstanding training fees up to the date of membership termination.  

7.   I authorize the Instructor, first aid or medical officer to consent where it is impractical to communicate with me to receiving such first aid or medical treatment as may be deemed necessary.

8.   I understand that an email must be sent to admin@flowstatebjj.com.au with a minimum of 14 days notice is required to cancel or suspend my Paysmart periodical payments. Failing sufficient notice, cancellation takes place on the subsequent withdrawal date.

10. I give permission for photos and video footage of myself (or the student hereby represented) training and/or competing to be used for promotional and advertising purposes. 

12. I undertake to abide by the FSMAF’s policies and guidelines and follow the traditions of the martial arts. 

13. I understand that the FSMAF may be alter their timetable during school holidays and the Christmas period, this time will provided in advance and fortnightly fees will still apply unless you choose to suspend in advance. 

14. I give permission for details of my medical condition and/or medical requirements to be stored for immediate access by the instructor should the need arise. 

Initial Box

 

Waiver release and assumption of risk

Please read carefully. This document affects your legal rights.

I, the undersigned (or parent) realise that serious injury in martial arts such as this one is likely and that even death is a possibility. I also realise that if I am injured, I might be disfigured, disabled and or rendered unable to work again. I realise that regardless of how these consequences may occur  whether it be the result of my action, an opponent’s actions, the action or inaction of a training partner, instructor, the condition of the mats used, the conduct of a non-participant or any other reason

Agree Checkbox

 By entering into this agreement I accept the risk of training and being present at Flow State Martial Arts and Fitness and give up and waive all claims I or anyone acting on my behalf or through me might have against Flow State Martial Arts and Fitness, any and all of the instructors at FSMAF, training partners, operators, sponsors, officials, participants, non-participants or any employees and/or representatives for any injury regardless of its nature, effect or affect on me as a result of my participation and or presence at Flow State Martial Arts and Fitness.

Agree Checkbox

I authorise whatever medical personnel, which may be present at Flow State Martial Arts and Fitness to take any action necessary should I become injured.

Agree Checkbox

I represent that I am in good health, that I am not presently nor will I participate while under the influence of any illicit drug or medication. I confirm that no one affiliated with Flow State Martial Arts and Fitness has adversely encouraged me to train or made any representations regarding my fitness or ability to participate.  I have read and understood every provision of this release and affirm that I am legally competent and of sound mind, and freely enter into this waiver, release and assumption of risk agreement.

Agree Checkbox

If pregnant, I have recieved expert medical advice and have been cleared to train Brazilian Jiu Jitsu. I will notify the coaches and monitor my own participation.

Agree Checkbox

Additional Signature Box   Date of Signing

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Existing Medical Conditions

Please list any existing medical conditions or prescribed medicines that may impact your training or physical health
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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