top of page
Northside MT Ltd – Membership & Waiver Form

If you are under 18 years old

Medical Information (please select Yes or No)

1. Do you have any history of heart trouble?
2. Have you ever experienced pain or tightness in your chest?
3. Have you ever had a stroke?
4. Do you have high or low blood pressure?
5. Do you often suffer from severe dizziness?
6. Do you have a bone or joint problem that could be made worse by a change in physical activity?
7. Do you have diabetes?
8. Are you pregnant?
9. Do you know any reason why you should not do physical activity?

If you answer ‘Yes’ to any of the above questions, you will need a doctors release to use the clubs classes and facilities.

If your health changes so that you answer YES to any of the above questions, it is paramount you inform the coaches or management team of Northside MT Ltd as soon as possible.

This physical activity clearance is valid for a maximum of 12 months from the date and becomes invalid if your condition changes so that you would answer YES to any of the questions and inform the training professional.

Student/Member represents that they are in good physical condition and is able to use the facilities of Northside MT Ltd. Student/Member here by acknowledges that they are fully aware of the risks and hazards inherent in the practice of martial arts and in fitness activities and hereby assumes voluntarily all risks of loss, damage or injury (including death) that may be sustained by Student/Member or to their property.


Student/Member hereby accepts full responsibility for the use of, or participation in, any and all classes, services, equipment, demonstrations or events, whatsoever owned, operated or sponsored by Northside MT Ltd, whether on-site or off-site and hereby releases and agrees to hold Northside MT Ltd, its owners, officers, directors, members, employees, representatives and agents from any and all loss, claim, injury, damage or liability sustained or incurred by Student/Member resulting there from. This release shall be binding upon the heirs, distributes, next of kin, executor and administrator of each of the undersigned. In signing this Agreement, the undersigned hereby acknowledges and represents that that they have read this release, understands it and signs it voluntarily.


Permission to receive First Aid if required:
Permission to allow photographs/video to be taken and used for marketing purposes:
Upload Photo

Thanks for submitting!

bottom of page