HomeAthlete Registration Form

State squad registration

Membership Status *

Previous Member Seeking Selection

Previous Member Seeking Selection
New Member Seeking Selection

First Name *

Last Name *

Address *

Apt, suite, etc.

Country *

Town or Suburb:

Postal Code: *

Gender

Male

Male
Female

Date of Birth *

Mobile Phone *

What age will you be as of the athlete age cut-off date for the National Championships 25/8/23

Parent / Guardian Name *

Parent / Guardian Mobile Phone Number *

Parent / Guardian E-mail

Club / Organisation Name

Head of Style Name

Personal Coach Name

You must be insured to compete in AKF competitions. I am insured through my Club / Organisation.

Yes

AKF Membership Number

AKF National Championships.

Please nominate your category(s) for State Team Selection.

Kata

Female Kumite

Male Kumite

Weight

If you suffer from any recurring injury physical disabilities or disorders, please provide details.

If you have suffered any recent illness or injuries, please provide details.

Further Medical Details: If you have any further details which may assist us in taking care of you during the training and/or event please document them here. You may also wish to discuss any concerns with the WAKF personally.

Nomination as a Volunteer (WAKL Events)*

Table OfficialMarshallSet Up (Not at each event)Pack Up (Not at each Event)Catering - Tea/Coffee - Lunch

State Team/Squad Members are required to Volunteer at Minimum 3 WAKL / State Tournaments. If you are not able to help then a family member is required to volunteer.

State Events available to Volunteer at:-*

WA Karate League 1 (Shobukan)State Karate ChampionshipsWA Karate League 2 (Wado)WA Karate League 3 (Goju)

As above states that it is a requirement as a State Team member to volunteer at 3 events. If you are not able to help then a family member is required to help. If a parent is helping at the Nationals you will be able to take time out to watch your child/children compete.

Consent

Yes

By completing this form you consent for an WAKF representative to authorise emergency medical treatment on the advice of a qualified medical practitioner. In addition, consent is also authorised for a qualified WAKF representative to administer first aid in the case of an accident or minor ailment occurring in related Squad/Team activities and/or event with the State Team.

Full Name

Declaration

I, the undersigned, in consideration of, and as a condition of acceptance of my membership to the WAKF State Squad for 2023 for myself, heirs, executors and administrators, hereby waive all and any claims, which I or they might otherwise have, arising out of any loss of life, injury or loss of any description whatsoever, which I may sustain in the course of or as a consequence of my training with the said Organisation. The waiver, release and discharge shall be in favour of all persons, joint or severally involved in the instruction or management of the said Organisation.
I have read and understood, and as a condition of acceptance of my membership to the WAKF State Squad for 2023, hereby agree to the conditions set out in the State Team Policy & Guideline and Code of Behavior provided on the WAKF website.

Date

Parent / Guardian Name

If under the age of 18

Date

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