Sign up - Judo Her Way @ MTG

Member Details

* Required field

Visitor Member

* First name

* Last name

* Gender

* Phone Number Add secondary Phone +

Secondary Phone

* Email Address

Add secondary Email +

Secondary Email Address

* Date of birth

* Parent/Guardian's name

Address

Street address

City

Zip / Postal code

State

Country

Contacts

Contact Name

Phone Number

Relation

Additional Contact

Photo

Edit Photo

Drag to reposition photo

Zoom

Rotate

Delete Photo Apply

Capture from camera No camera found. Please connect a camera to use this feature. Upload or use camera Upload photo

Waiver / liability release

Photo and Video Release Form

Please note: This form is not mandatory. If this form is unsigned, MTG Judo Club shall not use media of the member in any way described below.

I, {name}, or a legal guardian or representative of {name}, hereby grant MTG Judo Club permission to use images and videos of {name} taken during club activities.

Images and videos of the member will be used on the following platforms only:

MTG Judo Club Website (mtgjudoclub.com)
MTG Judo Club Social Media
Judo Queensland Website
Judo Queensland Social Media
Judo Australia Website
Judo Australia Social Media
Corinda Bowls Club Website
Corinda Bowls Club Social Media

If at any time the member wishes to revoke this media release, the member must do so in writing to a MTG Judo Club committee member.

Done Clear Sign Below:

Signature

Medical Conditions

Known Medical Conditions

How did you hear about us?

Who referred the member to us?

More details:

Account Password

Please pick a password to log-in to your account later.

Password (minimum 8 characters)

Confirm Password