RKC BEGINNER'S COURSE REGISTRATION FORM
RKC Beginner's Course Registration Form 
- Last Updated 2024/01/25

PLEASE NOTE - There should be one completed form for each RKC member (e.g. a family of 4 who decides to join the RKC will require 4 (four) forms to be completed - one for each family member.
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Email *
Which RKC Beginner's Course are you registering up for? *
Which dojo branch do you foresee as being the dojo branch that you will train the MOST at? *
DEFENCE UNLIMITED CC T/A RKC DOJO (RKC) RELEASE FROM LIABILITY AND ASSUMPTION OF RISK (ADULT & MINORS)
PLEASE READ CAREFULLY and COMPLETE ACCORDINGLY
I have applied to RKC’s Beginner's Course for either myself, or as the guardian of behalf of the minor (under 18 year old). My name is: *
I certify that I am not aware of any medical condition which would render me, or the minor mentioned above whom I am a guardian of, unfit to participate in any exercise program and that I will inform RKC immediately of any change in my medical condition. *
I authorize any representative of RKC to obtain emergency medical treatment, including transportation to a hospital or other medical facility for me, or for the minor mentioned above whom I am a guardian of, should an accident occur and warrants medical attention.  *
I UNDERSTAND AND ACKNOWLEDGE THAT THERE ARE RISKS INHERENT IN ANY MARTIAL ARTS AND/OR EXERCISE PROGRAM INCLUDING BUT NOT LIMITED TO HEART ATTACK, STROKE, ORTHOPEDIC INJURY, INJURIES CAUSED BY THE USE OF MARTIAL ARTS EQUIPMENT AND OTHERS. THESE INJURIES CAN OCCUR SUDDENLY AND WITHOUT WARNING, AND MAY RESULT IN DEATH. I AM VOLUNTARILY PARTICIPATING (OR ALLOWING THE MINOR MENTIONED ABOVE FOR WHOM I AM THE GUARDIAN OF) IN THIS TRAINING PROGRAM WITH KNOWLEDGE OF THE DANGERS INVOLVED, AND I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS ABOVE. *
FOR AND IN CONSIDERATION OF PERMITTING ME TO PARTICIPATE IN THE PROGRAM, I, FOR MYSELF, THE MINOR MENTIONED ABOVE WHOM I AM A GUARDIAN OF, AND FOR MY HEIRS, BENEFICIARIES, AND PERSONAL REPRESENTATIVES, HEREBY RELEASE AND FOREVER DISCHARGE DEFENCE UNLIMITED CC T/A RIVONIA KENDO CLUB (RKC) AND ITS DIRECTORS, OFFICERS, MEMBERS, MANAGERS, EMPLOYEES, AGENTS, ATTORNEYS, INSURERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, “RKC PARTIES”), FOR ANY AND ALL CLAIMS, DEMANDS, DAMAGES, LOSSES, LIABILITIES, RIGHTS, ACTIONS, CAUSES OF ACTION, EXPENSES, AND SUITS OF ANY KIND WHATSOEVER, FORESEEN OR UNFORESEEN, FOR PERSONAL INJURY, WRONGFUL DEATH, DAMAGE TO PROPERTY, OR OTHERWISE RESULTING FROM MY PARTICIPATION IN THE PROGRAM AND/OR THE ACTS OF OMISSIONS OF ANY OF CROSSFIT NEW HAVEN PARTIES, INCLUDING ANY AND ALL NEGLIGENT ACTS, WHETHER ACTIVE OR PASSIVE, IRRESPECTIVE OR WHETHER SUCH INJURIES, DEATH, OR DAMAGES OCCUR DURING TRAINING OR THEREAFTER. *
I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AT LEAST 18 YEARS OF AGE. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND RKC AND I SIGN IT OF MY OWN FREE WILL. *
MEDIAN RELEASE STATEMENT - I grant permission to Defence Unlimited CC Trading As “RKC DOJO” hereinafter known as “RKC” to use my, or that of minor for whom I am the guardian of,  images (photographs and/or video) for use in Media publications including: Videos, Email Blasts, Recruiting Brochures, Newsletters, Magazines, General Publications, Website and/or Affiliates, Various Social Media platforms. I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. *
DEFENCE UNLIMITED CC T/A RKC DOJO  (RKC) - MEMBER’S  INFORMATION
Kindly complete this section for the person who will be doing the training (e.g. in the case of someone completing this form on behalf of someone else, this would be the information of the "someone else".)
Full Name *
Date of Birth *
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Current Age *
RSA ID NUMBER (or PASSPORT NUMBER FOR NON-SA CITIZENS): *Required for SAKF Personal Liability Group Insurance *
EMAIL ADDRESS(ES): *
CELL NUMBER: *
PHYSICAL ADDRESS:
OCCUPATION:
IN CASE OF EMERGENCIES (ICE) 1 - Name, Relation, Contact Number *
IN CASE OF EMERGENCIES (ICE) 2 - Name, Relation, Contact Number
MEDICAL ISSUES THAT YOU ARE AWARE OF THAT MAY HAMPER YOUR TRAINING:
ANY MEDICATION THAT YOU ARE ON CURRENTLY?
DO YOU HAVE MEDICAL AID? IF SO, WHICH PROVIDER?
You will be given a club t-shirt when you enroll as a member of our club, so please tell us your T-shirt size (we have both men and women sizes).

Additional T-Shirts cost R200 each 
Details of Person responsible for billing (full name, contact number, email address) *
Any other questions you might have regarding your RKC DOJO membership?
The RKC Dojo is a firm believer that effective and constant communication (not spam) is key to ensuring both the students' commitment to training and development, as well as the dojo's objective to retain students. Therefore, please select the 3 most effective ways of communicating with the student and/or member. *
Required
POPI ACT AGREEMENT AND CONSENT DECLARATION
YOU HEREBY DECLARE AND CONFIRM THAT YOU, AS THE PERSON/ENTITY/BODY/INDIVIDUAL/COMPANY WHOSE IS PROVIDING INFORMATION AND HEREINAFTER COLLECTIVELY REFERRED TO AS THE “CLIENT”, DO HEREBY IRREVOCABLY AGREE AND UNDERSTAND THAT ANY/ALL INFORMATION SUPPLIED OR GIVEN TO THE SERVICE PROVIDER, IS DONE SO IN TERMS OF THE BELOW TERMS AND CONDITIONS AND IN
TERMS OF THIS AGREEMENT AND CONSENT DECLARATION.

1. INTERPRETATION
1.1 In this Agreement, unless inconsistent with or otherwise indicated by the
context –
1.1.1 “This Agreement” means the Agreement contained in this document;
1.1.2 “The Company/Service provider” means DEFENCE UNLIMITED CC T/A RKC DOJO and includes its affiliated, holding and subsidiary companies;
1.1.3 “Confidential information” includes, but is not limited to:
1.1.3.1 any information in respect of know-how, formulae, processes, systems, business methods, marketing methods, promotional plans, financial models, inventions, long-term plans and any other information of the client and the company in whatever form it may be;
1.1.3.2 all internal control systems of the client and the company;
1.1.3.3 details of the financial structure and any other financial, operational information of the client and the company; and
1.1.3.4 any arrangements between the client and the company and others with whom they have business arrangements of whatsoever nature, all of which the client and the company regards as secret and confidential.
1.1.4 “personal information” means personal information as defined in the Protection of Personal Information Act adopted by the Republic of South Africa on 26 November 2013 and includes but is not limited to:
1.1.4.1 information relating to the race, gender, sex, pregnancy, marital status, national, ethnic or social origin, colour, sexual orientation, age, physical or mental health, well-being, disability, religion, conscience, belief, culture, language and birth of the person;
1.1.4.2 information relating to the education or the medical, financial, criminal or employment history of the person;
1.1.4.3 any identifying number, symbol, e-mail address, physical address, telephone number, location information, online
identifier or other particular assignment to the person;
1.1.4.4 the biometric information of the person;
1.1.4.5 the personal opinions, views or preferences of the person;
1.1.4.6 correspondence sent by the person that is implicitly or explicitly of a private or confidential nature or further correspondence that would reveal the contents of the original correspondence;
1.1.4.7 the views or opinions of another individual about the person;
and
1.1.4.8 the name of the person if it appears with other personal information relating to the person or if the disclosure of the name itself would reveal information about the person.
1.1.5 “the effective date” means the date of signature of this Agreement’;
1.1.6 “the parties” means the parties as described hereinabove;
1.1.7 “divulge” or “make use of” means to reveal, make known, disclose, divulge, make public, release, publicise, broadcast, communicate or correspond or any such other manners of divulging of any information.
1.1.8 ‘‘processing’’ means any operation or activity or any set of operations, whether or not by automatic means, concerning personal or any information, including but not limited to :
(a) the collection, receipt, recording, organisation, collation, storage, updating or modification, retrieval, alteration, consultation or use;
(b) dissemination by means of transmission, distribution or making available in any other form; or
(c) merging, linking, as well as restriction, degradation, erasure or destruction of information.
1.1.9 POPI” means the Protection of Personal Information Act adopted by the Republic of South Africa on 26 November 2013 and as amended from time to time.

WHEREAS IT IS AGREED THAT
All parties agree that they will comply with POPI regulations and process all the information and/or personal data in respect of the services being rendered in accordance with the said regulation and only for the purpose of providing the Services set out in the agreement to provide services.

The company (also called the service provider), all the parties to this agreement, the service provider’s employees and the client’s employees and any subsequent party/parties to this agreement acknowledge and confirm that

- One or more of the parties to this agreement, will possess and will continue to possess information that may be classified or maybe deemed as private, confidential or as personal information.
- Such information may be deemed as the private, confidential or as personal information in so far as it relates to any party to this agreement.
- Such information may also be deemed as or considered as private, confidential or as personal information of any third person who may be directly or indirectly associated with this agreement.
- Further it is acknowledged and agreed by all parties to this agreement, that such private, confidential or as personal information may have value and such information may or may not be in the public domain.

For purposes of rendering services on behalf of the client, the service provider and any party associated with this agreement and/or any subsequent or prior agreement that may have been/will be entered into, irrevocably agree that “confidential information” shall also include inter alia and shall mean inter alia:
(a) all information of any party which may or may not be marked “confidential,” “restricted,” “proprietary” or with a similar designation;
(b) where applicable, any and all data and business information;
(c) where applicable the parties may have access to data and personal and business information regarding clients, employees, third parties and the like including personal information as defined in POPI regulation; and
(d) trade secrets, confidential knowledge, know-how, technical information, data or other proprietary information relating to the client/service provider or any third party associated with this agreement and (including, without limitation, all products information, technical knowhow, software programs, computer processing systems and techniques employed or used by either party to this agreement and/or their affiliates.

By signature hereunder, all parties irrevocably agree to abide by the terms and conditions as set out in this agreement as well as you irrevocably agree and acknowledge that all information provided, whether personal or otherwise, may be used and processed by the service provider and such use may include placing such information in the public domain.

Further it is specifically agreed that the service provider will use its best endeavors and take all reasonable precautions to ensure that any information provided, is only used for the purposes its has been provided.

It is agreed that such information may be placed in the public domain and by signature hereunder, all parties acknowledge that they have read all of the terms in this policy and that
they understand and agree to be bound by the terms and conditions as set out in this agreement.

It is confirmed that by submitting information to the service provider, irrespective as to how such information is submitted, you consent to the collection, collation, processing, and
storing of such information and the use and disclosure of such information in accordance with this policy.

SHOULD YOU NOT AGREE TO THE TERMS AND CONDITIONS AS SET OUT IN THIS AGREEMENT AND CONSENT DECLARATION YOU MUST NOTIFY THE SERVICE PROVIDER IMMEDIATELY FAILING WHICH IT WILL BE DEEMED THAT YOU ACCEPT AND AGREE TO THE TERMS AND CONDITIONS SET OUT ABOVE
Name *
Date *
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