Register | Invictus Combat Karate School

Invictus Combat Karate-Jutsu

Affiliation and Registration Form

Affiliated to Shukokai Shito-Ryu

Important legal notice

This document constitutes a legally binding agreement between the member (and/or their parent or legal guardian, where applicable) and Invictus Combat Karate-Jutsu (“the organisation”). By signing this form, you acknowledge that you have read, understood, and agreed to all terms and conditions set out herein. If you do not understand any provision, you are strongly advised to seek independent legal counsel before signing. This document is governed by the laws of the Republic of South Africa.

Section A — Registration information

Registration number Assigned automatically when you submit.

Joining date

Dojo name *

Instructor *

Belt rank / grade *

Section B — Member personal details

First name(s) *

Surname *

Date of birth *

ID / passport number * SA ID: 13 digits, or passport number

Gender *

Nationality *

Cell / WhatsApp *

Email address *

Physical address *

Medical information

Do you have any medical conditions? *

Yes No

Medical conditions

Do you take any chronic medication? *

Yes No

Chronic medications

Blood type

Known allergies

Physical disabilities or limitations

Previous injuries relevant to training

Section C — Emergency contact details

Emergency contact full name *

Relationship to member *

Cell / WhatsApp *

Alternative number

Email address *

Section D — Medical aid details

(Please complete in full. This information is required for emergency medical purposes and to facilitate treatment at any event, camp, competition, or training session. Leave blank if not applicable.)

Do you have medical aid? *

Yes No

MedicalAid name

Name of plan/option

MedicalAid membership number

MainMember full name

MainMember ID number

Main member date of birth

Main member contact number

Main member email address

Relationship of main member to student

Note: If the student is not the main member on the medical aid, the organisation shall use the main member’s details provided above when seeking authorisation for emergency medical treatment. The member (and/or parent/legal guardian) authorises Invictus Combat Karate-Jutsu to present these details to any medical facility or emergency services provider in the event of a medical emergency.

Section E — Parent / legal guardian details

(Mandatory if the member is under 18 years of age.)

Full name *

ID number *

Relationship to member *

Cell / WhatsApp *

Home / work tel *

Email address *

Physical address *

Add secondary guardian

Section F — Declaration and signatures

We, the undersigned, hereby confirm that:

I / we have read and fully understood all the terms, conditions, waivers, and indemnities set out in this form (view terms);
I / we agree to be bound by all provisions contained herein;
I / we sign this document freely and voluntarily, without duress or undue influence;
All information provided in this form, including medical and medical aid details, is accurate and complete to the best of my / our knowledge;
I / we understand that Invictus Combat Karate-Jutsu is affiliated to Shukokai Shito-Ryu, and that membership is subject to the rules of both organisations (view rules);
I / we acknowledge that an annual affiliation fee of R300.00 is payable regardless of the date of joining during the calendar year;
I / we acknowledge that the monthly membership fee is R350.00 and that this fee is non-refundable regardless of attendance;
I / we acknowledge that private one-on-one lessons with Sensei Jimmy Janvier Nzabanterura are available at R500.00 per session, bookable separately and subject to availability.

I / we confirm the declaration above.

Member / adult student

Signature *

Sign below with your mouse or finger.

Name *

Date *

PARENT / LEGAL GUARDIAN

(Required if the member is under 18 years of age.)

The member is under 18 years of age (complete the parent / legal guardian declaration below).

Upload ID or birth certificate * JPG, PNG, or PDF only. Max 5MB.

Upload passport photo * Recent passport-size photograph. JPG or PNG only. Max 5MB.

Upload full photo * Recent full-length photograph. JPG or PNG only. Max 5MB.

New students: Please upload both a passport-size and a full-length photograph.

Create your account

You will log in with the email address you entered in section B.

Password * Minimum 8 characters

Confirm password *

Invictus Combat Karate-Jutsu

Section A — Registration information

Section B — Member personal details

Medical information

Section C — Emergency contact details

Section D — Medical aid details

Section E — Parent / legal guardian details

Secondary guardian

Section F — Declaration and signatures

Member / adult student

PARENT / LEGAL GUARDIAN

SECONDARY PARENT / LEGAL GUARDIAN

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