Membership | The Dojo Woking

The Dojo Woking
Membership Form and Liability Waiver

First Name

Phone

Next of Kin/Relationship

Last Name

Date of Birth

Mobile

Contact Number

Please specify anything we should know about you

Do you have a doctor’s permit to participate in intense physical activities?

Yes

From time to time we use photos and videos of our classes for promoton purposes online, in fliers, adverts and other printed promotional mediums. By ticking the box, I confirm that I give permission to The Dojo Woking to use this material where me or my child/children may appear.

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

I declare that the info I’ve provided is accurate & complete

Signature. If under 18yo, Parent/Guardian must sign.

Date

Thanks for submitting!

07921 395476

The Dojo Woking Membership Form and Liability Waiver

The Dojo Woking
Membership Form and Liability Waiver