ABERDEENSHIRE BLACKBELT CLUBS

ANNUAL MEMBERSHIP APPLICATION FORM

FORENAME

SURNAME

ADDRESS

POSTCODE

EMAIL

MOBILE

DATE OF BIRTH

Have you done previous martial arts training before? YES NO If yes –

Name of Club

Name of Instructor

Duration of training ____________________________

Grade achieved ______________________________

Occupation (adults)

Do you have a criminal record? YES NO

If yes, please disclose nature of conviction: _____________________________________________________________

________________________________________________________________________________________________

MEDICAL DISCLOSURE
The activities provided by Aberdeenshire Blackbelt Clubs (ABC) are physically demanding and will require a certain level of cardio-respiratory endurance. If for
whatever reason applicants have medical conditions which impede full utility in any part of the muscular, skeletal, cardio-respiratory or nervous systems; they should
disclose this information in writing and attach with application. This is also the case with applicants who have Additional Support Needs.

DECLARATION & WAIVER

I have read, understood and answered all the above questions honestly and have provided correct/current information about my health. I agree to inform my
instructor/coach immediately of any changes to the above information, should it have an impact on my participation and membership. I understand that certain
elements of ABC training can be physically demanding, and as a condition of my membership, I can certify that I am physically and emotionally capable of safely
participating and accept full responsibility for my participation and for my own physical and emotional well-being. I confirm that I have received a copy of ABC rules
and agree to follow them. I understand and accept that there is an element of risk associated with learning and practicing martial arts (and martial arts based
activities), whereby the resultant injury or accident could be fatal. I have watched a session being taught and agree as condition of membership, not to hold the
instructor, any other member or ABC liable for an injury I may sustain while part-taking in any ABC activity.
The information contained in this form is data covered within the terms of the Data Protection Act (1984). Data provided will be held on computer and will be used
by ABC only for administration purposes.

Applicant’s signature _________________________________ (parent or guardian if under 16 years) Date_________________

I HAVE PAID THE £35.00 ANNUAL MEMBERSHIP – in cash (when returning form) Bank transfer