Membership Details and Medical QuestionnairePersonal Details This form is confidential and not disclosed to any other party.Name in Full *Student Name in full pleaseDate of Birth *DaySelect day12345678910111213141516171819202122232425262728293031MonthSelect month123456789101112YearSelect Year20302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960Full Address *CountyEir CodePhone *Mobile number is preferable Email Address *OccupationAnnual Membership Fee Payment *Bank TransferPaypalCashPlease indicate your preferred method of paymentMonthly Subs Fee Payment *Bank TransferPaypalCashPlease indicate your preferred method of paymentWhat motivated you to join our school?Do you have any medical conditions that you think you should notify or declare to Inspiration Taekwon-Do? *If none apply please state "None"Before submitting this questionnaire we ask that you read the following points very carefully EMERGENCY / ILLNESS: In the event of illness, having parental responsibility I give permission for medical treatment to be administered where considered necessary by a nominated first aider or suitably qualified medical practitioner. If I cannot be contacted and my child needs emergency hospital treatment I authorise a qualified medical practitioner to provide emergency treatment or medication. *I AcceptPHOTOGRAPHS: I understand that photographs will be taken at or during Taekwon-Do related events and will only be used in the promotion of Taekwon-Do and Inspiration Taekwon Do. *I AcceptCODE OF ETHICS FOR YOUNG PEOPLE: I hereby consent to the child named above/overleaf, participating in activities of Inspiration Taekwon Do in line with the Code of Ethics for Young People. I will inform the instructors or administration of Inspiration Taekwon Do of any changes in the above information immediately. *I AcceptThe Code of Ethics for Young People is available on the website for referenceThe following information is required in case of emergency. We insist upon having two telephone numbers. These numbers are treated in a confidential manner and will not be released to any other party.Name *Number *Name *Number *I confirm that I have answered the above questions correctly to the best of my knowledge; I understand that Taekwon-Do is a martial art and a contact sport and therefore my instructor, Inspiration Taekwon Do or agents acting on behalf of the above cannot be liable for any injury that may be sustained as a result of participation in the programme. I accept that the onus is on me as a parent / guardian or adult to ensure that my child or I have adequate personal insurance cover in case the need for medical treatment or otherwise should arise as a result of injury. *I AcceptSend RegistrationPlease do not fill in this field.