BRISBANE
AIKIKAI
SEMINAR 1st - 3rd May 2015
We are pleased to invite you to a course with
N obuo Takas e S hi han 7th D an
Takase Shihan is Chief Instructor of Aikido Shinryukan &
Technical Director for New Zealand Aikikai
Venue: Brisbane Aikikai Dojo
95 Commercial Rd, Newstead
Cost:
Full Weekend $120.00
Sat/Sun AM or PM only $50.00
Friday evening only $20.00
Enquiries: 0412094654
Session Times:
Friday:
6:15pm—7:30
Saturday: 9.30am—12.00
and 1.30pm—4.15
Sunday: 9.00am—12.00
and 12.30pm—2.00 (Gradings)
Group dinner will be held Saturday night:
6:30pm at the International Hotel, Spring Hill
Please click this link to register your interest
WWW.AIKIDOBRISBANE.ORG
Brisbane Aikikai
Takase Shihan Seminar 2015
Registration and Waiver
Please read carefully before signing and complete all areas. This form must be
signed and witnessed (where appropriate) for your registration to be accepted.
A separate form is required for each attendee.
Name………………………………………………………………………………….
Date of Birth………………………………
Address…………………………………………………………………………………
………………………………………………………………………………………….
State …………
Postcode………………………………..
Home Phone …………………..
Mobile………………..
Email……………………………………………………….
Do you have any existing injuries, medical conditions, or limitations that may affect your
safety or that of others during training? No Yes (circle)
If yes please provide details
……...……………………………………………………………………………………………
…………………………………………………………………………………………………..
Emergency contact name……………………………………………………….
………………
Telephone…………………………………..
Aikido Training Experience:
Style …………………
Dojo………………
Grade………….
Yrs training…………….
Fee Payment: Please make all payments to BANK: Commonwealth Bank of Australia. BRANCH
Graceville. Account Name Aikido Brisbane Aiki-Kai National School. BSB 064 111 Account Number
1017 1456. *Please be sure to include your name on the remittance advice*.
IMPORTANT WAIVER OF LEGAL RIGHTS – PLEASE READ CAREFULLY
I acknowledge that Brisbane Aikikai may carry no insurance against liability for injury to any of its students or persons present at the Takase Shihan Seminar
2015. I agree that before using the mat or any equipment at the seminar, I will inspect the facilities, and if I believe that anything is unsafe I will immediately
advise the organisers and will refuse to participate in training any further.
I will not attempt any activity that exceeds my level of skill and/or training. I realise that the study of aikido requires proper conditioning and training.
I understand that there are risks and dangers associated with aikido training, including but not limited to: bodily injury, communicable diseases, partial or total
disability, and death. I understand that, in accordance with the law, Brisbane Aikikai does not exclude from training individuals with medical conditions that do
not pose a medically recognised threat to the health and safety of themselves or other students in the normal course of training. I understand that there may be
some circumstances in which these medical conditions will require special caution on my part to minimise danger to myself and others and I acknowledge that
it is my responsibility to act on all such occasions with a corresponding level of care.
I understand that some students may be infected by HIV/AIDS, hepatitis B or other diseases which can be transmitted by the exchange of blood or other bodily
fluids and that I may be training with them. I agree that I will follow exactly any instructions that may be given that are aimed at minimising the spread of communicable diseases.
I understand that risks and dangers may be caused by the negligence of myself or others whilst I am attending the Takase Shihan Seminar 2015. Such negligence may result from the acts or omissions of my training partner, others who are training around me, the organisers of the Takase Shihan Seminar, their
agents, guests, or instructors of Brisbane Aikikai. They may also result from the state of the premises in which the seminar is taking place (‘the premises’).
I voluntarily assume all risks of death, illness or personal injury sustained whilst participating in, or observing the Takase Shihan Seminar 2015,
whether or not these risks are caused by the negligence of any other person (natural or legal).
I agree to accept all such risks and responsibility for all loss and damage consequent upon them, whether caused in whole or in part by the negligence of Brisbane Aikikai, its representatives, agents, guests, instructors, other participants in the Seminar; or by the owners or occupiers of the premises (including their
officers, directors, agents and employees).
I release Brisbane Aikikai, Mr Nobuo Takase Shihan and any other instructors at the Takase Shihan Seminar, together with the agents, instructors,
employees of and all individuals associated with Brisbane Aikikai and with the premises (hereinafter referred to as ‘Related Parties’) from all liability,
claims, demands or actions whatsoever arising out of damage, loss or injury to me while upon the premises or while participating in aikido training or
associated activities, whether such loss, damage, or injury results from negligence or otherwise.
I agree that I will not sue or make claim against related parties in respect of any loss or injury arising from my participation at the Takase Shihan Seminar, or
from the state of the premises.
I understand that aikido is an educational system. I agree to abide strictly by the training rules of Brisbane Aikikai and to follow exactly all instructions given by
instructors during the course of my training. I agree to watch out for others in the training area and while training on the mat and to follow all rules posted or
explained to me. Should I break any of these rules I understand that it is the decision of the seminar organisers whether I may continue training. I will abide by
their decision.
In signing this agreement I am stating that I know what I am doing and that I take responsibility for my own acts, that I have read carefully and understand this
agreement and that I fully agree with each statement contained in the agreement and that I am responsible for myself and will be considerate of others.
I MAKE THIS AGREEMENT ON BEHALF OF MYSELF, MY SUCCESSORS, EXECUTORS AND DEPENDANTS. I ALSO CERTIFY THAT I AM AN
ADULT OVER 18 YEARS OF AGE.
Participant’s Name ……………………………
Participant’s Signature ……………………….....
Date ……………
Witness Name ……………………………..
Witness Signature……………………………………………..
For Parents or Guardians of Minors (if participant is under 18 years of age)
I consent to allow the minor named above to participate in aikido training at the Takase Shihan Seminar 2015 I agree that he or she will do so subject to the
terms and conditions of the waiver set out above and agree to bind myself, the minor, and all successors, executors and dependants of the minor to those terms.
I will instruct the minor to inspect the facilities and that if (s)he believes anything to be unsafe (s)he will immediately advise the seminar organisers and will
refuse to participate in further training.
I agree on behalf of the named minor to waive all legal rights he or she may hold against Brisbane Aikikai, Mr Nobuo Takase Shihan, any other guest instructors of the Takase Shihan Seminar, agents, instructors, employees of and all individuals associated with Brisbane Aikikai or the premises, in respect of any
personal injury, disability or illness resulting from the minor’s participation at the Takase Shihan Seminar, or use of the premises. I undertake to indemnify
Brisbane Aikikai against all liability for all such injury or loss, howsoever caused.
Parent/Guardian’s Name………………………..
Parent/Guardian’s Signature………………. …. Date…………..
Witness Name…………………………………..
Witness Signature……………………………………………………