MEMBERSHIP APPLICATION FORM
Membership No.:
Please write clearly in BLOCK LETTER. Thank you.
2 recent
passport-size
photographs
required
Personal
NAME:
(Given name)
(Family name)
NAME IN CHINESE:
NRIC / BC / FIN NO:
DATE OF BIRTH:
GENDER: M / F
AGE:
NATIONALITY:
MARITAL STATUS:
ADDRESS:
EMAIL:
CONTACT NO.:
(HOME)
OCCUPATION:
(MOBILE)
(OFFICE)
COMPANY:
PRINCIPAL DOJO:
DATE JOINED:
CLASS DAY & TIME:
PREVIOUS MARTIAL ARTS EXPERIENCE & GRADE:
LIST ANY PAST INJURIES / MEDICAL PROBLEMS, IF ANY:
(e.g. heart attack, high blood pressure, diabetes, asthma, allergies, fractures etc.)
HAVE YOU EVER BEEN CONVITCED IN THE COURT OF LAW FOR ANY CRIMINAL OFFENSE?
NO
□
YES
□
(If yes, please specify)
In case of Emergency:
NEXT OF KIN
NAME/CONTACT NO.:
RELATIONSHIP:
I hereby agree to abide by all TERMS & CONDITIONS as stated overleaf and declare that all above information given
by me are true and correct. I hereby agree that any misinformation or untrue herein stated shall render my
application null nad void and my membership revoked even if the membership has been formally approved and any
monies paid shall be unrefundable.
APPLICANT’S SIGNATURE:
DATE:
(If below 21 years old, to be signed by parent or guardian)
PARENT’S/GUARDIAN’S NAME/SIGNATURE:
*Aikido Federation Singapore reserves the right to reject your application without any reason given.
(Please also sign on the reverse side)
For Official Use Only
□ Form Completed & Signed
□ Registration Fee: $25
□ 2 Photographs
□ Attendance Card Given
□ Membership Fee: $50/$30 □ Pro-rated Membership Fees: $
Total Fees:
INV Date & No.:
Approved □
Not approved □
Membership Book Done □
Database Updated □
□ Membership Booklet Given
From
to
Welcome to our Aikido lesson, please read the following Terms & Conditions carefully:
1.
2.
3.
4.
5.
6.
7.
8.
Aikido Federation (Singapore) “AFS” is the organization that conducts your Aikido lessons and the
current training centre that you have signed up with will be your Principal-Dojo. All Principal –Dojo
training fees must be paid before the start of every new term.
All students MUST sign the Deed of Waiver and Indemnity and return the form to your
Instructor/Leaders immediately. Students are not allowed to train without signing the form.
All students must be a member of Aikido Federation (Singapore) and as member will receive a
membership booklet for recording of grades, seminars attended and other details.
An Entrance fee of S$25.00 will include an AFS membership booklet and an annual subscription fee of
S$50.00 (Adult’s membership aged 13yrs and above) and S$30.00 (Junior’s membership aged 4-12yrs
old). Students who join after June pay half of Annual Subscription Fee. Two (2) passport photos are to
be submitted together with application form and fees.
Any member that leaves AFS for more than 3 calendar years will have to re-apply as a member.
Membership fee must be renewed annually before 31 December.
The age for regular children class is 5-12 years of aged.
Membership is strictly not transferable and nor refundable in the event of termination/revocation.
All terms and conditions is subject to changes from time to time without prior notice.
DEED OF WAIVER AND INDEMNITY
By this Deed,
I,
NRIC No:
(If below 21 years old, to fill in name and NRIC no. of parents or guardian)
irrevocably agree that neither Aikido Federation Singapore (AFS), its committee staff, servants, voluntary
helpers, students, agents, instructors, nor monitors shall be liable to me, for any loss of and/or damage to any
property or for any death or personal injury howsoever caused or sustained, whilst engage in lessons, training,
grading or taking part in demonstration in the art of Aikido wheresoever conducted and I hereby discharge
AFS, its committee staff, servants, voluntary helpers, students, monitors, agents, instructors, guests and
overseas instructors from all claims that I have against them.
In particular but without prejudice to the foregoing, I also agree that if I/the Minor should participate in any
other activities, relating to the art of Aikido, I/the Minor will do so entirely at my/his/her own risk and AFS, its
committee staff, servants, voluntary helpers, students, agents, instructors, and monitors shall be exempted
from all liabilities to me for any loss of and/or damage, and upon my death or personal injury.
I shall indemnify AFS, its committee staff, servants, voluntary helpers, students, monitors, agents, instructors,
guests and overseas instructors against all proceedings, claims, expenses and liabilities whatsoever which may
be taken or made against or incurred by AFS, its committee staff, servants, voluntary helpers, students, agents,
instructors and/or the monitors by reason of any claim or action of whatever nature which may be brought by
me or on my behalf in respect of the foregoing.
Signed, Sealed and Delivered by
Witness: (must be above 21 years of age)
Date:
Applicant’s Signature
Witness’s Name/Signature/NRIC No.
(If below 21 years old, to be signed by parent or guardian)