Judo Club Membership Registration Form

Sports Centre Ippon Registration Form

Please complete the form below to sign up Year 2019-2020
Member Name *

First Name Last Name
Date of Birth

Day Month Year
Date
Parent or Legal Guardian

First Name Last Name
Phone Number: *

Area Code Phone Number
Emergency Contact

First Name Last Name
Emergency Contact Phone Number

Area Code Phone Number
E-mail *
Address: *

Street Address

Unit #

City

Postal Code
Have you taken Martial Arts classes before?

Yes No
What Judo rank are you currently?
Do you have any medical history or conditions that could affect your ability to participate in contact sports? *

No Yes (Please enter details)
Medical Conditions
Are you a member of a recognized National Judo Organization?

Yes No
While being a member of a national judo organization is not required by Sport Centre Ippon for normal, in club activities, it is recommended, and is required for tournament play and participation in clinics and events at other judo clubs and venues. Members. Please ask an instructor about how to join.
I am a member of:

Canada National Judo Federation Canada Provincial Judo Federation
Provincial Judo Member Number
National Judo Member Number
Where did you hear about us?

A Friend or colleague Online Search (Google, Bing, Yahoo) Martial Arts Website Local Activities Listing News Article
Payment Policy
I understand that Sports Centre Ippon does not require members to sign a contract for an extended period of time, and members may cancel at any time by notifying a manager.

I understand that my first two classes are FREE with no obligation, and that after that my first month will be prorated.

I understand that Sports Centre Ippon is a non-profit entity and relies on the prompt club dues payments of members to stay open. A monthly invoice will be given to me in person or sent to me by email. I agree to pay my club dues prior to the 5th day of every months either by Cash, or Check payable to Sports Center Ippon. If I am unable to make a payment, I will notify a club manager and make an arrangement. Otherwise, Sports Centre Ippon hold the right to charge 15% extra fees for late payment. Club dues are tax deductible.

I understand that any stock judogi, belt, or promotion fee is payable upon delivery. Any special order items are payable before the order is placed.

Competitors Payment Policy:

Each competitor participating at the competitions in the province of Quebec will be charged Coach Assistance fees of $20.00

Each competitior participating at the competitions outside of the province of Quebec will be charged Coach Assistance fees of $50.00
*

I have read and understand the payment policy
Membership Rules
MEMBERSHIP RULES
1. Never leave the mat or the dojo without receiving permission from the instructor.
2. No food, drink or chewing of gum are allowed on the mat.
3. No non-judo activity is to take place during class time. Show your instructor respect by paying attention. Save the conversation for after class.
4. Report all injuries to the instructor immediately. When arriving at class with an injury, the instructor must be notified prior to the start of class.
5. Shoes are NEVER to be worn on the mat.
6. Water bottles are permitted in designated area at mat-side. Water bottles are to have water or electrolyte beverages (like Gatorade) only.
7. Never come to class under the influence of drugs or alcohol.
8. Members are to keep their Judogis clean and in good repair.
9. Finger and toenails are to be kept clean and trimmed to a reasonable length to prevent injuries to training partners.
10. No jewelry may be worn during class unless specifically approved by the instructor.
11. Members without uniforms should not have anything in their pockets. Judo involves pulling on the clothing, and whatever you wear could become torn.
12. No practicing of judo skills or new techniques is allowed without permission of the instructor. This includes techniques you learned on the internet, saw during a competition, or on a video.
13. Spills are to be cleaned immediately. Trash should be placed in the proper container. Spectator chairs should be stacked at the end of class.
14. Bullying is not tolerated in or out of the dojo. Members using their Judo skills for bullying will not be allowed to return.
*

I have read, understood, and accepted the rules for membership.
Privacy Policy
I understand that occasionally, photos and videos from club competitions and practices will be used in promotional material for the club. I agree to allow my image or my child's image to be used for this purpose and that I will not be compensated. I also understand that once a promotional item has been produced, it is not possible to remove my image or my child's image from the production.
*

I understand that the club will never share my contact information for commercial purposes. I may, however, be contacted by the club managers about club announcements and information relevant to club membership.
Disclaimer and Waiver of Liability
1. Recognize and understand that martial arts training is a physical contact activity and that my participation might result in serious injury, including permanent disability or death, and severe social and economic loss.
2. Recognize and understand that such risk may be due to not only my own actions, but also the action, inaction or negligence of others.
3. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time.
4. Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform an instructor if I believe that anything is unsafe or beyond my capability and refuse to participate.
5. Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death.
6. Enter martial arts training and/or competition entirely of my own free will and understand the importance of following the rules of training and competition.
7. I certify that I am in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during training practice and/or competition. If I have any injuries or illnesses that could affect my ability to participate, I will notify the club managers and coaches, and discuss the appropriateness of martial arts training with my or my child's doctor.
8. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me or my child with medical assistance or treatment for such injury. The cost of any treatment or hospitalization arising from injury during training or play shall not under any circumstance be paid by Sports Centre Ippon, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents.
9. Release, waive, discharge and covenant not to sue, Sports Centre Ippon, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the realeasees or otherwise.
Signature of Member or Legal Guardian *

I have read, understood, and accept the disclaimer and liability waiver and sign it of my own free will
Should be Empty:

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Sports Centre Ippon Registration Form

Payment Policy

Membership Rules

Privacy Policy

Disclaimer and Waiver of Liability