Street Sense Self Defense Academy

Street Sense Self Defense Academy

ABN 15 337 942 098

APPLICATION FOR PARTICIPATION

SURNAME:-…………………………………………..FIRST NAME/S:-………………………………………………………

ADDRESS:-…………………………………………………………………………….POST CODE:-…………………………

DATE OF BIRTH:-……………………PHONE:-…….………………………………FAX:-…………………………………..

MOBILE:-…………………………………………E-MAIL:-………………………………………………………..……………

EMERGENCY CONTACT………………………………………………………PHONE:-.............................................

DISCLAIMER

I acknowledge that I have read and understand the definitions set out below.
I hereby acknowledge that my application and/or participation in any Self-Defense club or venue of the SSSDA or physical activity whilst practising Self-Defense carries with it a significant risk of personal injury.
I acknowledge that I am both physically and mentally healthy, if for any reason I have any doubt about any health issues, I will fully disclose this information in writing prior to application for participation.
If I am under 18 years of age a parent or guardian must sign my application.
Therefore, I for myself and the releasors hereby relinquish, release and waive any action against the releasees for any personal injury sustained by me arising out of and/or in the course of the Self-Defense training or exercise or instructional directive or breach of any rules of Self-Defense training or otherwise.
In addition, in the event of any action being commenced, I for the releasors and myself hereby indemnify the releasees against any cost and damages arising or connected therewith.
I acknowledge that I have personal accident and health insurance.

DEFINITIONS

PERSONAL INJURY:- has its ordinary English meaning and includes any injury for which a person might be awarded under general damages and/or special damages at common law.
THE RELEASORS:- means the family, dependants, heirs, executors and/or assigns and any person or persons claiming through them.
THE RELEASEES:- means any business or corporation, association or other body and/or any person(s) jointly and/or severally and whether servants or agents of any of the aforementioned or otherwise where any such business or corporation, other body or individual is associated with the promotion or conduct of the SSSDA or any tournament and includes training partner(s), competitor(s), instructor(s), referee(s) and observers or any members of the public or any audience.
ANY ACTION:- means any claim, right and/or course of action for damages at common law or pursuant to any statute.
THE RULES:- means the rules for the time being of the SSSDA

DECLARATION

I have read the above application for participation rules, disclaimer and definitions, and I understand it clearly, and have filled in my application form correctly and honestly. I understand that there is a $50 membership fee to be paid upon joining. I agree that this disclaimer may be presented as documentary evidence in any legal proceedings. I have current accident and health insurance and hereby sign below.

PARTICIPANT SIGNATURE:-……………………………………………………………….DATE:-…………………………

PARENT/GUARDIAN SIGNATURE:-……………………………………………………..DATE:-………………………….

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