var_Venue
*
var_Hosting_Club
*
var_Sport
*
var_Date
*
-
Day
-
Month
Year
Date
Underwater Hockey "Have a Go" Day Registration
Hosting Club: {var_hosting_club}
Event Date: {var_date}
Venue: {var_Venue}
Participant Name
*
Mr
Mrs
Miss
Mst
Dr
Prefix
First Name
Last Name
Date of Birth
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
Number
Gender
*
Male
Female
N/A
Guardian Name (if participant is under 16)
First Name
Last Name
Phone Number:
*
-
Area Code
Phone Number
Additional Guardian Name or Emergency Contact
First Name
Last Name
Alternate or Emergency Phone Number
*
-
Area Code
Phone Number
E-mail (for club newsletters)
*
Autocompleted Address
Does the participant suffer from any of the following Medical conditions?
Asthma
Heart problems
High Blood Pressure
Diabetes
Epilepsy
Other Medical Conditions
Please list any other medical conditions the participant is being treated for at present.
Has the participant Snorkeled before?
*
No
Yes
Has the participant Scuba dived before?
*
No
Yes
Are you interested in finding out more about these Sports?
*
No
Yes
Do you have any medical history or conditions that could affect your ability to participate in contact sports?
*
No
Yes (Please enter details)
Where did you hear about us?
A Friend or colleague
Online Search (Google, Bing, Yahoo)
Martial Arts Website
Local Activities Listing
News Article
Other
Membership Rules
MEMBERSHIP RULES
Never leave the mat or the dojo without receiving permission from the instructor.
No food, drink or chewing of gum are allowed on the mat.
No non-judo activity is to take place during class time. Show your instructor respect by paying attention. Save the conversation for after class.
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.
Shoes are NEVER to be worn on the mat.
Water bottles are permitted in designated area at mat-side. Water bottles are to have water or electrolyte beverages (like Gatorade) only.
Never come to class under the influence of drugs or alcohol.
Members are to keep their Judogis clean and in good repair.
Finger and toenails are to be kept clean and trimmed to a reasonable length to prevent injuries to training partners.
No jewelry may be worn during class unless specifically approved by the instructor.
Members without uniforms should not have anything in their pockets. Judo involves pulling on the clothing, and whatever you wear could become torn.
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.
Spills are to be cleaned immediately. Trash should be placed in the proper container. Spectator chairs should be stacked at the end of class.
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
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.
Recognize and understand that such risk may be due to not only my own actions, but also the action, inaction or negligence of others.
Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time.
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.
Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death.
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.
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.
Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me with medical assistance or treatment for such injury.
Release, waive, discharge and covenant not to sue, Ocala Judo Club, 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.
*
I have read, understood, and accept the disclaimer and liability waiver and sign it of my own free will
Signature of Member or Legal Guardian
*
Save
Submit Application
Print Form
Should be Empty: