West Cumbria Aikido - Member Registration

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This form should be used for new members and existing members on return to training and on annual renewal. By submitting this form, you give permission for West Cumbria Aikido to record and store your personal details and to pass this information to our governing bodies and our insurance company. This information will not be passed to any other third party, will be used solely for aikido purposes and will be held in accordance with data protection requirements.

By submitting this form you confirm that you have read, understand and agree to abide by our Health, Safety and Welfare requirements and associated risk assessments (https://www.westcumbriaaikido.com/health-safety-and-welfare).

Note, you must inform us of any medical conditions or disabilities that may affect your practice of aikido. This includes any respiratory, heart/blood or nervous disorders, epilepsy, allergies, migraines etc. Please provide details below which will be kept in strictest confidence. Failure to disclose something may invalidate your insurance.

Email *

Date of Application (new or renewal) *

YYYY

Your Name *

Name of any juniors (<18yr), their age and gender who will accompany you *

Gender

Female

Male

Prefer not to say

Other:

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Date of Birth *

YYYY

Address *

Mobile Phone number *

Health conditions to declare (including relevant allergies and medication etc) *

Status *

I am happy for photographic and/or video imagery of myself to be used for the promotion of aikido (adults only) *

Yes

I wish to be added to the club WhatsApp group *

Yes

Emergency Contact Name and Telephone Number

A copy of your responses will be emailed to the address you provided.

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