Name of participant _________________________________________________________________________________-


Address :____________________________________________________________________Post code_____________


Phone Home________________________________________mobile___________________________________________________




Name of Class _____________________________________________________________________________


Class day_________________________________Class time______________


Medical History


1. Does the participant take any medication ? YES / NO ( please circle )


2. Does the participant have any conditions which may affect their participation in Shashido activities ? YES / NO


If you answered yes to 1 or 2 above please list below :




I, as parent/guardian confirm it is in order for myself/child/children to participate in Shashido class activities


I agree to hold harmless  Shashido Enterprises and/or it’s subsidiary or associated companies and contractor’s


against any liability relating to damage to property and death or injury to any person.


Signature :____________________________________________________________________  Date :   __________

( Parent or Guardian if participant is under 18 years of age )


Print Name :___________________________________________________________________Date :___________


Shashido Class Declaration For Non-Members


I_________________________________________________________give my permission

( parent or guardian )



                                                      ( name of child )

to attend Shashido class activities under the care of _______________________________________________


I understand my child will not be eligible to attend lessons unless the above mentioned Shashido member is in attendance each lesson.


_________________________________________________________________________________________________– ( Parent / Guardian signature )