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.
DATE OF BIRTH ________
EMERGENCY TELEPHONE NUMBER
EMERGENCY CONTACT NAME
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.
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
TICK AS APPROPRIATE:
INSURANCE ONLY (YOU MUST HAVE THIS
INSURANCE AND LOG BOOK
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.
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;
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
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
ISAMI RYU - THE SCHOOL OF THE RISING SPIRIT
To Build True Confidence
Through 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.
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.
_ Parent / Guardian
(if under 16)
ISAMI RYU MARTIALARTS ACADEMY
VOLUNTEER APPLICATION FORM
information received in this form will be treated confidentially
Date of Birth
Previous work experience & relevant qualifications
Have you previously been involved in voluntary work?
If yes, please give details:
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?
Have you completed Safeguarding Awareness
If yes, who was it organised by and when approximately
Do you agree to undergo specific training on the role of the (position
Have you ever been asked to leave any organisation in
(if you have answered yes we
will contact you in confidence)
Any other relevant
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.
Details of a senior member of the club who has proposed or endorses this application
DISCLOSURE OF CRIMINAL CONVICTIONS APPLICANT:
Please read this information
Statement of non-discrimination
is 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
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
so, please state below the nature, date(s) and sentence of the offence(s)
provide any other information you feel may be of relevance such as:
- The circumstances
of the offence/incident
- A comment on the sentence received
relevant developments in your situation since then
- Whether or not you feel the conviction has
relevance to this post.
I declare that any answers are complete and correct to the best of my knowledge and I will inform the IRMAA Designated
of any future convictions or charges relevant to my role. I give my
a CRB check to take place and for this information to be shared as
part of any
risk assessment process.
Date application received:
Date of interview/discussion:
Outcome of discussion/interview
received and are satisfactory:
CRB check completed & returned
Number of CRB:
of applicants identification received:
Approve / Not approved
FOR OFFICIAL USE ONLY
(Appendix E) ISAMI RYU MARTIAL arts
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?
In what capacity?
3. Please comment
on the persons honesty, character and trustworthiness
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.