UTS Jitsu Application Form
Affiliated to Sydney Jitsu Inc
PARTICIPANT TYPE
Adult (18+) - Primary Applicant
Minor (Under 18) - Requires Guardian Consent
APPLICANT DETAILS
Full Name: {name}
Date of Birth: {dob}
Mobile: {phone}
EMERGENCY CONTACT / GUARDIAN (Required for Minors)
Name: {contact_name}
Relationship: {contact_relation}
Mobile: {contact_phone}
HEALTH DECLARATION
Is participant prescribed any drugs which may impair reaction time or judgement?
Yes No
If yes, which drugs:
Has participant, within the past 5 years, suffered any blackout, seizure, convulsion, fainting or dizzy spells, or any incapacity that would render it unsafe to participate in martial arts?
Yes No
If yes, please give details:
Is participant fitted with any electronic device or shunt?
Yes No
If yes, please give details:
Name & identify any current physical impairment, injuries or medical conditions affecting participant (e.g. back injuries, weak ankles etc)?
Yes No
If yes, please give details:
Is there any other medical information or health needs our instructors should be aware of for the participant's safety?
Yes No
If yes, please give details:
Privacy Note: I consent to the collection and use of the health information provided above solely for the purpose of ensuring my safety (or the safety of the minor) during training.
ACKNOWLEDGEMENT
I acknowledge that:
- I have been given a reasonable opportunity to read this document in full before signing.
- I have been advised that I may seek independent legal advice before signing.
- I have had the opportunity to ask questions about any terms I do not understand.
- I am signing this document freely and voluntarily.
I confirm the above acknowledgements
Initials:
TERMS AND CONDITIONS
⚠️ WARNING: MARTIAL ARTS IS A DANGEROUS RECREATIONAL ACTIVITY ⚠️
The following conditions must be read carefully.
Applicants are advised that Japanese Jiu-Jitsu involves physical, and at times, full body contact between participants, as well as the use of training weapons. Classes include strenuous physical activity. Accordingly, the school and its instructors advise that anyone enrolling does so at their own risk.
While taking all possible care, neither the school nor its instructors will be held responsible for any damage and/or injury occurring as a result of training. It is the student's (or parent's) responsibility to advise the school of any illness or disability. No students are forced to take part in any activity they do not feel confident performing.
The school reserves the right to refuse admission to any person who poses a danger to themselves or others.
CONTRACT TERMS
1. Interpretation "The Applicant" means the individual signing this Contract and includes a guardian if the individual is under 18.
2. Acceptance The Applicant agrees to be bound by the terms with UTS Jitsu and Sydney Jitsu Inc ("the providers").
(a) Club Fees The Applicant will pay prescribed fees as notified via letter, notice, or verbal instruction.
(b) Invitation-Only Sessions Supplementary sessions are designated as "invitation-only" and:
- Are not included in regular membership fee calculations.
- Are offered at the sole discretion of the providers.
- May be cancelled without notice and are not eligible for refunds or credits.
(c) Session Cancellations
- If a regular session is cancelled, the providers will use reasonable endeavours to offer a makeup session.
- Where the number of cancelled regular sessions in a single semester exceeds two (2), the Applicant is entitled to a pro-rata credit toward future fees for each subsequent cancelled session.
- Credits must be claimed within 60 days of the semester's end and are not redeemable for cash.
(d) Summer Closure Period UTS Jitsu closes between the end of the Spring exam period and the start of Autumn Orientation (mid-Dec to early Feb). No credits or refunds apply to this scheduled closure.
(e) Medical Conditions The Applicant warrants they have not suffered blackouts or seizures in the last 5 years and are not receiving treatment that makes training unsafe.
(f) Rights of a Consumer Under the Australian Consumer Law or Fair Trading Act 1987 (NSW), certain rights cannot be excluded. Liability for breach of these warranties is limited to re-supplying the service or paying the cost of having the service supplied again.
(g) Waiver and Indemnity Except where inconsistent with the ACL, the Applicant indemnifies the providers from all liability for injury or damage (including negligence) arising from participation or use of the facilities. I acknowledge that martial arts is a "dangerous recreational activity" under Section 5K of the Civil Liability Act 2002 (NSW) and voluntarily assume the obvious risks inherent in such activity.
(h) Martial Arts not to be taught by Applicant The Applicant is not authorised to teach UTS Jitsu publicly or privately for gain without written authorisation.
(i) Code of Conduct The Applicant agrees to abide by the UTS Jitsu Code of Conduct. Failure to do so may result in expulsion.
(j) Governing Law This agreement is governed by the laws of New South Wales.
(k) Electronic Execution Executed in accordance with the Electronic Transactions Act 2000 (NSW).
(l) Personal Property The providers are not liable for damage to clothing or jewellery (which should not be worn) or loss of personal items left on the premises.
RECREATIONAL SERVICES NOTICE
Australian Consumer Law - Section 139A
YOUR RIGHTS: The supplier must ensure services are rendered with due care and skill and are reasonably fit for purpose. Under section 139A, the supplier is entitled to ask you to agree that these statutory guarantees do not apply to you. By signing this form, you agree that your rights to sue the supplier if you are killed or injured (because the services were not provided with due care and skill) are excluded, restricted, or modified as set out below.
EXCLUSION OF LIABILITY: By signing, I agree that the liability of UTS Jitsu and Sydney Jitsu Inc for death, physical or mental injury, or disease resulting from the supply of recreational services is excluded to the full extent permitted by law.
LIMITATION: This exclusion does not apply to "reckless conduct," defined as conduct where the supplier was aware (or should have been) of a significant risk and engaged in it without justification.
I have read and understood the Recreational Services Notice.
Initials:
ADDITIONAL PROVISIONS FOR MINOR PARTICIPANTS
Where the Applicant is under 18, the Parent/Guardian:
- Consents to the minor participating.
- Acknowledges they have explained the obvious risks to the minor.
- To the full extent permitted by law, agrees to indemnify the providers against claims brought by or on behalf of the minor.
MEDIA CONSENT
I consent to photographs/video being taken for promotional use (without identifying my/the minor's name).
Yes, I consent
No, I do not consent
DECLARATION AND FINAL SIGNATURES
⚠️ MARTIAL ARTS IS DANGEROUS ⚠️
I certify that all information provided is true. I have read and understood the terms.
IF APPLICANT IS 18+:
Full Name:
Date: {sign_date}
IF APPLICANT IS UNDER 18 (Parent/Guardian to sign below): I, the undersigned, am the Parent or Legal Guardian of the Minor Applicant named above. I have read this document, explained the risks to the Minor, and I sign this agreement for and on behalf of the Minor and as a personal guarantee of the Minor’s obligations.
Parent/Guardian Full Name:
Relationship to Minor: {contact_relation}
Address: {address}
Date: {sign_date}
MINOR PARTICIPANT’S ACKNOWLEDGEMENT (Ages 12-17)
I, the Minor Applicant, have had the risks of martial arts explained to me. I agree to follow the Club Rules and the Code of Conduct, and I understand that training involves physical contact and risks. Minor’s Initials:
Date: {sign_date}
UTS Jitsu
