Name of participant _________________________________________________________________________________-
Address :____________________________________________________________________Post code_____________
Phone Home________________________________________mobile___________________________________________________
Email_________________________________________________________D.O.B.______________________Age_______________
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 )
for______________________________________________________________________
( 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 )
