Family Onboarding | Quan Wessels Martial Arts

Online indemnity form

Complete the below form to sign up for your membership

Primary Member

Primary Member Membership Level *

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First Name *

Identity Number *

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Password *

Last Name *

Email *

Rank

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Cell *

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Emergency Contact

Emergency Contact First Name *

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Relationship with Emergency Contact *

Emergency Contact Cell *

Emergency Contact Home Tel

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Health History

Physical disabilities / allergies / illnessess if any

Dependent Members

Total Family Member Cost

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Acceptance

Membership Terms and Conditions *

I Accept the Membership Terms and Conditions

Click hereto read the Membership Terms and Conditions

Assumption of Risk and Waiver of Liability *

I Accept the Assumption of Risk and Waiver of Liability

Click here to read the Assumption of Risk and Waiver of Liability

Online indemnity form

Primary Member

Emergency Contact

Health History

Dependent Members

Acceptance

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