Membership Application

Tetsushinkan Budojo Membership Record
Entry Date:
NAME:

Member Number:
D.O.B.:

ADDRESS
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Post Code.............................................................
Telephone.............................................................
Email address.......................................................
Emergency Contact Name....................................
Emergency Contact Phone...................................
MEDICAL
Enter any
condition that
may affect
your
participation

Comments/Progress Record

I undertake to comply with the etiquette of the Budojo (Martial Arts Centre) and will not do anything to
bring the practice of Bujutsu (Martial Arts) into disrepute.
I have observed the practice of Aikido/Kashima Shinryu at Tetsushinkan Budojo and understand that it
is an intensive and dynamic activity involving physical contact. I accept that, despite reasonable
precautions taken, there remains some risk of injury and I herby assume that risk.
Signed:............................................................................... Date .............
For Admin purposes
Date Form completed................................................Completed by ............................Memb paid..............................