Participant's Name *

First Name

Last Name

If the participant is under the age of 18.

Parent / Guardian's Name

First Name

Last Name

Phone Number

(###)

###

####

Why would you like to try Judo? *

Fun / Social sporting activity

Sporting success

Develop physical mobility and fitness

Self Defence

Being bullied at school / work

Build confidence / self-esteem

Try a different Martial Art

Returning to Judo after an absence

Other

Waiver of Release and Liability: *

I recognise the inherent risks of participating in Judo. If the participant is under the age of 18, as the parent/guardian of the above-mentioned child, I recognise the inherent risks of participating in Judo. I agree on behalf of myself or my child, to release and hold harmless Waverley Judo, its officers, and employees from all liabilities and claims that arise from mine or my child’s participation.

Accepted

Assumption of Risk *

I understand the risks involved and consent to participate in the activities. If the participant is under the age of 18, I understand the risks involved and consent for my child to participate in the activities. I assume all responsibility for any risks, injuries, or damages, know or unknown, which might occur as a result of mine or my child’s participation.

Accepted