Registration

 

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Joining Registration

Membership Registration Form:

You should, as a member, re-register every year for insurance purposes. You can fill in the form below & print it out, or e-mail it to the club secretary for processing. It is also possible to ask for a printed form at the club, which can be filled in by pen. Please note that we will NOT pass any information on to any third parties, unless required to do so by law. You should apply for your new licence in plenty of time; say one month before the old one runs out.

Full Name

 

Date of Birth

 

 DD.MM.YYYY

Mark the box to say 'yes' Please mark the 'bullets' below to indicate if the answer is 'yes'

Have you ever practiced a Martial Art Before? if so state style & grade        

Previous AMA Licence expiry date:

Do you suffer from any of the following?

Allergies?     Asthma?       Hay Fever?      Nervous Disorder?

Respiratory? Diabetes?     Heart?             Haemophilia?

Migraine?     Epilepsy?      H.I.V.?            Other? (Give details)

Details

Details of regular medication

Do you have any of the following?

Body Piercing? (including earrings)

Details

IMPORTANT TERMS OF MEMBERSHIP:

All body piercing's, including earrings MUST be removed before you go onto the mat. If they cannot be removed for some genuine medical reason, they MUST be fully taped up and covered, to the satisfaction of the senior instructor on-mat.

You must not wear any jewellery of any sort on the mat, not even a wristwatch or a ring. You must not carry anything in your pockets onto the mat at all.(such as coins for example).

You must never step onto, or leave the mat without advising an instructor beforehand. You will never train (with a friend for example) on the mat without an instructor being present on the mat and fully aware of your presence. All 'traditional' martial arts codes will be observed on the mat & in the dojo at all times, rules unknown to you will be taught, however students of, and above the rank of RED BELT (or having attended the club for a period of 3 months, whichever comes first) will be expected to know, understand  & observe ALL rules at ALL TIMES.

Contact Details Address
Post/Zip code
Phone number
Mobile phone  

we will use your cell phone to contact you with text messages of an urgent nature such as last minute cancellations.

  E mail
DECLARATION & LICENCE Type of licence applied for

Adult over 18 (not Black Belt)     Under 18              Dan Grade

YOU MUST READ AND ACCEPT THE FOLLOWING STATEMENTS:

I accept that the practice of Martial Arts / combat sport involves the risk of serious injury. I will uphold the code, and the Terms of Membership (as above) of the Aiki-Shin in all respects, and observe all rules at all times. I understand that it is my responsibility alone to maintain my A.M.A. licence and keep it up to date without break at any time.

I AM OVER THE AGE OF 18

I AM UNDER THE AGE OF 18

If you are under 18, the following must be read, understood & filled in by your parent or legal guardian:

As the responsible person signing for a student under the age of 18, YOU accept the responsibility of explaining to your child, the importance of all the club rules, as outlined above. You must sign the box below, or print your name if applying on line.

I give my permission that any Club Association photographs that may include me / my child on them, may be published in the Aiki-Shin name. (Children appearing in club photographs will always be anonymous except where specific permission has been obtained from the parent or guardian)

Signature of Student (IF OVER 18 Years)            

Signature of adult person signing on behalf of the underage student

Name of person signing box IF NOT the student applying for this licence

Relationship to student

 

Fee to be paid: Please note you can apply online, but payment can only be given to Sensei Lee in person on Saturday morning. Your application WILL NOT be processed until your fee is received, & the printed copy is signed in pen. We accept cash or cheque.
Cheque's should be made payable to ' Mr W Johnson '

Child under 18:            £17.50

Adult NOT dan grade   £25.00

Dan grade:                  £65.00


Copyright (c) 2008 Aiki-Shin Liverpool. All rights reserved.
office@leehallard.co.uk