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(Appendix A)
MEMBER APPLICATION

Anything written on this form will be held in confidence. Our group leaders need to know these details in order to meet your specific needs or those of your child.


CONTACT DETAILS      


NAME:                    _________________________________



DATE OF BIRTH                                    ________             



ADDRESS:                                                                      



                                            ______________________________________________________


TELEPHONE             _____                                              



EMERGENCY TELEPHONE NUMBER                                      



EMERGENCY CONTACT NAME                                              



RELATIONSHIP                                                                 



M
EDICAL CONDITIONS



ARE THERE ANY MEDICAL CONDITIONS, WHICH YOU FEEL YOU OUGHT TO MENTION? THIS WILL NOT IN ANY WAY AFFECT YOU MEMBERSHIP BUT WILL HELP TAILOR YOUR TRAINING TO ANY SPECIFIC NEEDS

I will inform my Instructor of any important changes to my health or to the health of my child, and of any medication or any changes to address or phone numbers given. I will also advise the club were appropriate, of the names of anyone who is not permitted to collect my child from the club and the action that must be taken by the club in this event.


In the event of illness or accidents to me or to my child, having parental responsibility for the above named child I give permission for medical treatment to be administered to me or to my child where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. In the case of a child, if I cannot be contacted and my child should require emergency hospital treatment, I authorise a member of the club designated by the group leader to see appropriate emergency treatment.



OTHER EXPERIENCE IN MARTIAL ARTS


STYLE

CLUB NAME

GRADE ACHIEVED








PLEASE TICK AS APPROPRIATE:


INSURANCE ONLY (YOU MUST HAVE THIS         £6


INSURANCE AND LOG BOOK                             £14


Isami Ryu is committed to ensuring that any information gathered in relation to our Club meets the specific responsibilities as set out in the Data Protection Act 1998.


Isami will store the above information for a maximum of 12 months before re- registering the member if still associated with the club. You will be required to complete the membership form annually.


I have been made aware that Isami Ryu have developed a Safeguarding policy & they are commitment to ensure my safety or the safety of my child by having. I confirm that I am responsible for reading the documents available on the club web site and I agree to abide by their content:


  • IRMAA's constitution which includes;

  • IRMAA's Safeguarding policy which includes;

  • IRMAA's Health and safety Policy

  • IRMAA's Equality Statement

I give permission for my child to attend for training sessions and to receive the appropriate support to help them develop their techniques within class, and that this may include physical interaction for training purposes and measures employed to ensure safety in class in agreement with the club's polices above. Yes/No/NA


I give permission for myself or for my child to be involved in any publicity, including photographs and videos, surrounding activities organised by the club. Yes/No/NA


I understand that I am responsible for making a decision on whether my child is left unsupervised in the club and in making this decision I will have considered all the factors relevant to my child and to their safety (as per polices and procedures above). N/A


I confirm that all details are correct to the best of my knowledge and I am able to give parental consent for my child to participate in all club activities. Yes/No/NA


PLEASE SIGN BELOW (OR IF UNDER 16, PARENT OR GUARDIAN NEEDS TO SIGN)





(Appendix B)
Club Code



ISAMI RYU - THE SCHOOL OF THE RISING SPIRIT
 
To Build True Confidence T
hrough Knowledge in the mind honesty in the heart and strength in the body.

To keep friendship with one another and to build a strong community.


Never fight to achieve selfish needs, but to develop might for right.


Declaration


I promise to uphold the true honour, spirit, discipline and respect of Isami Ryu.


I will never use what I learn in the dojo except in defence of myself, my family, my friends or to uphold the law.



 
                            Members Signature



                            _ Parent / Guardian

(if under 16)



(Appendix C)

ISAMI RYU MARTIALARTS ACADEMY



VOLUNTEER APPLICATION FORM




All information received in this form will be treated confidentially


Name:


Address:


Date of Birth



Telephone No.


Mobile No


Previous work experience & relevant qualifications


Have you previously been involved in voluntary work?


If yes, please give details:


Yes No


Do you have any spare time hobbies, interests or specific skills that may be useful to the activities?


Do you agree to abide by the IRMAA creed and declaration?


Yes No


Have you completed Safeguarding Awareness

Training?


Yes No


If yes, who was it organised by and when approximately


Do you agree to undergo specific training on the role of the (position being appointed)


Yes No


Have you ever been asked to leave any organisation in the past?


(if you have answered yes we will contact you in confidence)


Yes No


Any other relevant information?

Please supply the names of a responsible person whom we can contact and who from personal knowledge are willing to endorse your application. If you have had a previous involvement in a sports club one of these names should be that of an administrator / leader in your last club / place of involvement.


Name:

Address:


Telephone:

Designation:




Details of a senior member of the club who has proposed or endorses this application


Name:

Address:


Telephone:

Designation:


(Appendix D)
DISCLOSURE OF CRIMINAL CONVICTIONS APPLICANT:

Please read this information carefully.

Statement of non-discrimination

IRMAis  committed to equal opportunity for all  applicants  including those with criminal convictions. Information about criminal convictions is requested to assist the selection  process  and  will  be  taken  into  account  only  when  the  conviction  is considered  relevant to the role. Any disclosure will be seen in the context of the criteria for the role,  the nature of the offence and the responsibility for the care of existing clients\volunteers and employees.


The role you are applying for involves working directly with children and vulnerable adults.  Under the rehabilitation of offenders Act 1974 you are required to provide details of any convictions that are not spent, in addition you are required to disclose any cautions or bind over's you have received over the last 12 months.


The disclosure of a criminal record or other information will not debar you from appointment unless IRMAA considers that the conviction renders you unsuitable. In making this decision NAME OF IRMAA will consider the nature of the offence, how long ago it was committed and what age you were at the time and other factors which may be relevant. This information will be verified through an appropriate disclosure check.


Please complete this form as accurately as possible and return with your application form to the person responsible in your club. An arrangement will be made with you to discuss any clarification if required.Thank you for your co-operation


Have you ever been convicted of a criminal offence or been the subject of a caution or the subject of an investigation alleging that you were the perpetrator of adult or child abuse? Yes / No


If so, please state below the nature, date(s) and sentence of the offence(s)



Please provide any other information you feel may be of relevance such as:

  • The circumstances of the offence/incident
  • A comment on the sentence received
  • Any relevant developments in your situation since then
  • Whether or not you feel the conviction has relevance to this post.

Declaration

I declare that any answers are complete and correct to the best of my knowledge and I will inform the IRMAA Designated Safeguarding Children's

Officer of any future convictions or charges relevant to my role. I give my

consent for a CRB check to take place and for this information to be shared as

part of any risk assessment process.


S
ignature:                                      Date:




Date:


Applicant Name:


Date application received:


Date of interview/discussion:


Outcome of discussion/interview



References received and are satisfactory:


Yes No


CRB check completed & returned


(If appropriate):


Yes No


Number of CRB:



Comments:


Proof of applicants identification received:


Yes No


Identification type:


Recommendation


(With reasons)


Approve / Not approved

FOR OFFICIAL USE ONLY

(Appendix E)

      ISAMI RYU MARTIAL


 arts academy


CONFIDENTIAL REFERENCE FORM


The following person:


Has expressed an interest in volunteering for IRMAA.


If you are happy to complete this reference, any information will be treated with due confidentiality and in accordance with relevant legislation and guidance. Information will only be shared with the person conducting the assessment of the candidate's suitability for the post, if he/she is offered the position in question. We would appreciate you being extremely candid, open and honest in your evaluation of this person.


1. How long have you know this person?









2. In what capacity?









3. Please comment on the persons honesty, character and trustworthiness





This post involves substantial access to children.  As  an  organisation  committed  to the  welfare  and  protection  of  children,  we are anxious to know if you have any reason at all to be concerned about this applicant being in contact with children and young people. If you have answered YES we will contact you in confidence.




Please sign and print name below.


Signed: _                                               Date: _                                                  


Print Name: