New Member Sign Up This form handles new member sign-ups for all membership levels. Membership LevelAdults All Access (R1150/m)Adults Once A Week (R850/m)Kids Classes (R950/m)Kids Once A Week (R750/m)Family PlanBased on your Membership Level selection, you are signing up for one adult.Based on your Membership Level selection, you are signing up, and completing details, for one child.Based on your Membership Level selection, you are signing up, and completing details, for multiple members of the same family.Personal DetailsWhen you submit this form an email will be sent to you to complete your account setup on the QuanWessels website. With this account you will be able to log your training sessions.Will you be included in this membership?(Required)If you will be a participating member in this Family Plan select ‘Yes’. If you are creating a Family Plan and will not be a participating member select ‘No’ (eg. You are signing up two or more of your children) Yes No Name(Required) First Last Email(Required) Enter Email Confirm Email ID or Passport Number(Required)Date of Birth(Required) DD slash MM slash YYYY Mobile Phone(Required)Work PhoneBrazilian Jiu Jitsu Belt RankingWhiteWhite – 1 StripeWhite – 2 StripeWhite – 3 StripeWhite – 4 StripeBlueBlue – 1 StripeBlue – 2 StripeBlue – 3 StripeBlue – 4 StripePurplePurple – 1 StripePurple – 2 StripePurple – 3 StripePurple – 4 StripeBrownBrown – 1 StripeBrown – 2 StripeBrown – 3 StripeBrown – 4 StripeBlackHealth HistoryPhysical disabilities / allergies / illnessess if any(Required)Emergency Contact DetailsName(Required) First Last Relationship with Emergency Contact(Required)Email(Required) Mobile Number(Required)Work NumberChild's DetailsProvide your child’s detailsName(Required) First Last Age(Required)Date of Birth(Required) DD slash MM slash YYYY ID / Passport Number(Required)Physical disabilities / allergies / illnessess if any(Required)Additional Family Member DetailsNumber of AdultsSelect the number of additional adults to be included in your Family PlanPlease enter a number from 0 to 1.Number of ChildrenSelect the number of children to be included in your Family PlanPlease enter a number from 0 to 3.Additional AdultWhen you submit this form an email will be sent to this person to complete their account setup on the QuanWessels website. With this account they will be able to log their training sessions.Name(Required) First Last Email(Required) Mobile Number(Required)ID / Passport Number(Required)Date of Birth(Required) DD slash MM slash YYYY Physical disabilities / allergies / illnessess if any(Required)Child 1Name(Required) First Last ID / Passport Number(Required)Age(Required)Date of Birth(Required) DD slash MM slash YYYY Physical disabilities / allergies / illnessess if any(Required)Child 2Name(Required) First Last ID / Passport Number(Required)Age(Required)Date of Birth(Required) DD slash MM slash YYYY Physical disabilities / allergies / illnessess if any(Required)Child 3Name(Required) First Last ID / Passport Number(Required)Age(Required)Date of Birth(Required) DD slash MM slash YYYY Physical disabilities / allergies / illnessess if any(Required)AcceptanceMembership Terms and Conditions(Required) I Accept the Membership Terms and ConditionsAssumption of Risk and Waiver of Liability(Required) I Accept the Assumption of Risk and Waiver of Liability Click here to read the Assumption of Risk and Waiver of Liability Click here to read the Membership Terms and Conditions Signature(Required)
