Rising Stars Registration

Rising Stars Registration Form

Use this form to register for the next Southside Muay Thai & Fitness 'RISING STARS’ in-house sparring day event!

About You
Participant Full Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Mobile*
Sex*
Date Of Birth*

Day
Month
Year
Age*
Weight (Kg)*
Medical Information
We strongly recommend you consult a physician before attempting physical activity, to determine any potential conditions that may adversely affect your participation. If you have a pre-existing condition or illness, we encourage consultation with a general practitioner (GP), with a view to gaining medical clearance for participation.
Do You Have Any Injuries? If Yes, Please Provide Details Below
Do You Have A Pre Existing Medical Condition, Or Illness? If Yes, Please Provide Details Below
Training Experience
Date Started Training at SSMT (Approximate)*

Day
Month
Year
How Long Have You Been Training For? (Approximately)*
Current Level/Grade*
Emergency Contact Details
Emergency Contact Full Name*
Emergency Contact Mobile*
Emergency Contact Relationship To Participant*
Where Participant is Under The Age of 18, Please Provide Parent/Guardian Details Below
Parent/Guardian Full Name
Parent/Guardian Age
Parent/Guardian Mobile
Parent/Guardian Relationship To Participant
Registration
Date Of Submitting Registration*

Day
Month
Year
Acceptance*
I have read and accept the Southside Muay Thai and Fitness ‘RISING STARS’ in-house sparring day terms and conditions outlined below. Where the participant is under 18 years, a parent/guardian is required to accept on behalf of the minor. To finalise your Rising Stars registration, tap the submit button below.
Rising Stars: Assumption of Risk and Release from Liability
In consideration of being allowed to participate in the sport of martial arts, an activity that involves physical contact and potential injury, I hereby voluntarily assume all risks in participating in the Southside Muay Thai and Fitness ‘RISING STARS’ in-house sparring day, including travel to or from participation sites. I understand the supervision by sparring coordinators is not provided and by participating in this sparring, I am exposing myself to the risk of injury including but not limited to temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruise, ligament and/or cartilage damage, head, or spinal injuries, loss of use of arms and/or legs, eye and/or mouth damage, disfigurement or even death. I am also aware there are other inherent risks of injuries that may occur by my participation in the Southside Muay Thai and Fitness ‘RISING STARS’ in-house sparring day that cannot be specifically listed. I am also aware that the categories are going to be arranged by age, weight, and sex. Experience will not be taken into consideration, but the categories could be merged, with that said I understand that I could fight in a higher or lower category. I have carefully read the Assumption of Risk and Release from Liability and fully understand its contents. This agreement is between the Southside Muay Thai and Fitness, the sparring coordinators, officials and employees, and myself, and I have signed the document of my own free will. I hereby release from any and all liability as a result of my participation in the Southside Muay Thai and Fitness ‘RISING STARS’ in-house sparring day.

Rising Stars Registration

Rising Stars Registration Form

About You

Medical Information

Training Experience

Emergency Contact Details

Where Participant is Under The Age of 18, Please Provide Parent/Guardian Details Below

Registration

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