Application to Train

To sign up with us, please complete the form below.

New members are welcome to sign up using the form below; choose the type of membership from the drop down.

Once you submit this form, payment and policy instructions will appear.

Name *
Name
Date Of Birth
Date Of Birth
Preferred Telephone *
Preferred Telephone
Mailing Address
Mailing Address
Emergency Contact
Contact Name *
Contact Name
Primary Phone *
Primary Phone
Backup Phone
Backup Phone
Training Background
Date Begun Training
Date Begun Training
Waivers
Statement of Health *
I hereby certify that I (or my child or my ward) has no health problems that would endanger themselves or other students or instructors of Multnomah Aikikai during the practice and study of Aikido. I further certify that should any such health problems develop that I (or my child or ward) will inform the instructor of the class before participating in any class, demonstration or other activities conducted under the auspices of Multnomah Aikikai.
Waiver and Release *
I have been informed of the physical nature of the study and practice of the martial art of Aikido. I understand that the study of the martial art of Aikido necessarily involves bodily contact and strenuous exercise. I understand that because of this there is an inherent risk of injury that cannot be eliminated. I understand that by undertaking the practice and study of the martial art of Aikido that I am assuming the risk of possible physical injury to myself (or my child or ward). I understand these risks involved in the study and practice of the martial art of Aikido, and I hereby indemnify, hold harmless, release and forever discharge Multnomah Aikikai, its instructors and students, and the owner(s) of the property, from any and all claims which I or my estate may have which are directly or indirectly based on any injuries or health problems that result from or occur during or develop subsequent to my (or my child’s or ward’s) participation in classes, demonstrations or other activities conducted under the auspices of Multnomah Aikikai. I agree that any controversy or dispute I might have with Multnomah Aikikai arising out of any injuries or health problems associated with my presence and/or participation in any activities conducted under the auspices of Multnomah Aikikai shall be resolved by binding arbitration in accordance with the then effective rules of the Arbitration Service of Portland, Inc.
New Members *
I have read the dojo dues policy (posted on multnomahaikikai.com) and agree to abide by the terms. I agree to keep myself informed by reading the dojo bulletin boards and messages sent to the email address I have provided on the front of this form. I agree to update the dojo when my contact information changes and communicate if or when my membership status needs to change, by sending an email message to dojo@multnomahaikikai.com.
Disclaimer: Right to Exclude from Participation *
Multnomah Aikikai reserves the right to exclude students from practice for reasons of poor health, contagious illness or disruptive behavior issues.