STUDENT REGISTRATION & INDEMNITY FORM

STUDENT INFORMATION

Student Name: *

Student Surname: *

Student Date of Birth: *

Student I.D. No.: *

Cell No: *

Email Address: *

Residential Address:

PARENT / GUARDIAN (If Student is Under 18)

Parents Name & Surname:

Parents Cell:

Parents Email:

MEDICAL INFORMATION

Medical Aid Name:

Medical Aid No.:

Main Member:

Doctor’s Name:

Doctor’s Tel:

Allergies / Medical Conditions / Previous Injuries:

Student Height:

Student Weight:

EMERGENCY CONTACT

Emergency Contact Name:

Emergency Contact Relationship:

Emergency Contact Cell No.:

REFERRAL (Optional)

Who referred you to WCKMAC?

MEMBERSHIP AGREEMENT & INDEMNITY

Check to Agree:

I understand that participation in martial arts and physical training involves inherent risks, including the possibility of serious injury or, in rare circumstances, death.
I voluntarily participate in all WCKMAC activities and hereby release and indemnify West Coast Korean Martial Arts Centre (WCKMAC), its instructors, assistant instructors, students, volunteers, venue owners, and representatives from any liability for injury, loss, damage, or death arising from participation, except where caused by gross negligence or unlawful conduct.
I confirm that I (or my child) am medically fit to participate and will inform the Head Instructor of any medical conditions, injuries, or changes in health.
I agree to abide by the rules, policies, and Code of Conduct of WCKMAC.
I acknowledge that I have received and understand the current membership fees, payment policies, and that WCKMAC charges a monthly membership fee, not a fee per class attended.
I understand that all personal belongings brought onto the premises remain my own responsibility, and WCKMAC accepts no liability for any loss, theft, or damage.
I give permission for photographs and videos taken during training or official WCKMAC events to be used for promotional or educational purposes unless I notify the Head Instructor in writing.

I confirm that the information provided on this form is true and correct, and I agree to the terms and conditions of membership.

Signature of Student: *

Signature Date:

Signature of Parent/Guardian if student is under 18:

WEST COAST KOREAN MARTIAL ARTS CENTRE

📍 Hoff St, Flamingo Vlei, Cape Town, South Africa, 7441