Free Women’s Self Defence Workshop Registration Go backYour message has been sent Thanks for your registration. We will contact you soon. Preferred workshop date(required) Saturday 7th February 12 noon – 2pm Saturday 14th February 12 noon – 2pm Either Saturday 7th or 14th February 12 noon – 2pm Warning First name(required) Warning Family name(required) Warning Gender(required) Warning Date (YYYY-MM-DD)(required) Warning Mobile number(required) Warning Email(required) Warning Street number and name Warning Suburb Warning Postcode Warning Emergency contact Emergency contact name(required) Warning Emergency contact phone(required) Warning Disclosure Are there any health problems, injuries, or other issues that in the interest of your health, safety, and wellbeing, the Association should be aware of?(required) No Yes Warning If yes, give details Warning Martial Arts History Have you studied Martial Arts before? (required) No Yes Warning If yes, give details Style Warning Instructor Warning Where Warning Grade Warning Number of years Warning How did you find out about the workshop? Warning Randwick City Council Questions As this workshop is being funded by Randwick City Council under the Community Investment Program, we are required to ask you some questions before and after the workshop. The personal data collected will not be shared with any third party. The summary of the questionnaire results will be shared with the Randwick City Council, though no names or other personal details will be shared. Could you please answer the following: What do you hope to get out of the workshop? What specific techniques would you like to be shown? Warning At the moment, what is your degree of confidence of being able to avoid or diffuse a potential physical encounter? Not at all confident Not really sure Relatively confident Quite confident Warning At the moment, what is your degree of confidence in being able to defend yourself if necessary? Not at all confident Not really sure Relatively confident Quite confident Warning Conditions of participation Participants acknowledge that at all times whether travelling to or from the training location (dojo), or other training locations, or at the dojo or at other training locations, both their property and their person shall be entirely at their own risk and not undertake any action or commence any proceedings whatsoever against the organisation, their servants or agents for any injury or loss suffered by the participant however so the said injury or loss shall arise, whether by negligence of the organisation, their servants or agents or otherwise. It is a participant’s responsibility to manage their current and any future injuries and/or medical conditions before, during and after training sessions. Participants understand that it is necessary for there to be physical contact between the instructors and participants, and between the participants themselves. Participants understand that the personal data collected will not be shared with any third party. The summary of the questionnaire results will be shared with the Randwick City Council, though no names or other personal details will be shared. If I am accepted, I agree to be bound by the rules of the organisation, and I have read, fully understand, and agree to all the conditions.(required) Warning I understand and agree that it is solely my responsibility to seek and follow the advice/approval of a medical practitioner to join or continue training if there are any physical or psychological reasons why this training may not be suitable for me. (required) Warning Warning. SendSubmitting form Δ Share this: Click to share on Facebook (Opens in new window) Facebook Click to share on X (Opens in new window) X Like Loading...