Women’s Striking & Self Defence Course Application Form

Women’s Striking & Self Defence Course Application Form

Course Application Form to be completed to apply for a place on our course. It captures the applicants’ declarations and consents with regard to our requirements for the proper running of the course. If you are accepted onto the course, you will be agreeing to become a fixed term member of The Red Dragon Martial Arts Club for the duration of the course, including the course taster class.

Student Name

First

Last

Please let us know your full name for necessary communications relating to the course

Student Date Of Birth

Please let us know your date of birth so we can confirm that you are 18 years old or above

Student Mobile Phone Number

Please let us know your mobile phone number for necessary communications relating to the course

Students Email

Please let us know your email address for necessary communications relating to the course

Student fitness to participate

It is vital for a student’s safety that any relevant medical conditions are disclosed to the Club (e.g. Asthma, Epilepsy, Heart Disorders, etc.) You must notify us of any medical condition or any other reason that may have relevance to a student’s participation in martial arts.

Permission for medical treatment to be administered

I give permission

I give permission to administer First Aid at first instance and/or to call a qualified medical practitioner/ambulance should we deem it necessary.

Person to contact in the event of an emergency

First

Last

In the unlikely event of an emergency please provide a contact name and mobile number of someone we can contact on your behalf.

Student Declaration

I accept

I accept that neither the Instructor or club can be held liable for any injury which occurs during Club activities. I agree to accept the club rules and accept that the practice of Martial Arts involves the risk of injury. Striking & Self Defence is part of martial arts which is a contact sport. Students can and do get injured and the club cannot accept responsibility for any such injury, loss or accident arising from your participation in our course and ask that you are aware, agree and accept this by joining our club for the fixed duration of the course.

Data Protection

I give permission

It is a requirement of the data protection act 2003 that persons give their written authorisation to have their details recorded. By accepting, you are allowing your personal details to be recorded in the Club’s database. This database is not distributed to any other third party and is not used for any other functions.

Photographs & Videos

I consent to being photographed and/or videoed and the material being published by the club for promotional purposes
I do not consent to being photographed and/or videoed but accept that it could happen by accident or outside of the clubs control

Please note that if you do not agree to being photographed/videoed and published on the club website and/or social media page for whatever reason, you may be asked to step aside if such photos or video are being taken. The club accepts no responsibility should another member/visitor breach our photography/video policy and publish photos/video that include you; although this will be monitored it is out of our control.

Work Circumstances & Class Fee

I am in full-time paid work – €10/class
I am not in full-time paid work – €8.50/classs

Please indicate what your work circumstances are as the class fee is discounted from €10/class to €8.50/class for those that do not have full-time paid work currently.

The Course WhatsApp group

Please add my mobile number to the Course WhatApp Group

If there is a change (e.g. if a training had to be cancelled) or other urgent or important notices about club activities, the quickest way to communicate with the students is via the Course WhatsApp group. Only admins of the Course WhatsApp group are able to post messages in the Course WhatsApp group. Please note that if you choose to join the Course WhatsApp group, other members in the group will be able to see your mobile number but will not know who you are unless you are already a contact of theirs.

How did you hear about our Women's Striking & Self Defence Course?

As we are a voluntary not-for-profit club with limited resources, please let us know how you heard about the course as it will help us target our advertising for future courses.

Any additional comments

Please add any addition comments that are not covered above and you feel are relevant

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