Health Waiver & Consent Form 2025

If the participant is under 18, this form must be completed by a parent or legal guardian. Please ensure all information is accurate and kept up to date.

SECTION 1: Participant & Main Contact Details

1. First name of participant

2. Last name of participant

3. Date of Birth of Participant

Día

Mes

Año

4. Full Address

5. Email (of person completing the form)

6. Phone Number (of person completing the form)

SECTION 2: Parent / Guardian Details (if participant is under 18)

7. Parent / Guardian Full Name

8. Relationship to Participant

SECTION 3: Emergency Contact (Must be 18+)

9. Emergency Contact Full Name

10. Emergency Contact Phone Number

11. Relationship to Participant

SECTION 4: Health, Medical & Additional Information

(Include health conditions, allergies, injuries, medication, SEN, additional needs, or anything else relevant.)

12. Please tell us anything we should know to support you or your child safely.

SECTION 5: Consent & Acknowledgements

Full Contact & Risk Acknowledgement: I understand that Muay Thai, boxing and fitness training are full-contact physical activities and that participation carries a risk of injury, even when sessions are supervised.

Health Information Confirmation: I confirm that the health and medical information provided is accurate and that I will inform Radojunkie of any changes.

Emergency Medical Consent: In the event of an emergency, I give permission for Radojunkie staff to seek medical treatment for me or my child if I cannot be contacted.

Safeguarding & Behaviour Acknowledgement: I understand that Radojunkie operates safeguarding procedures and that inappropriate or unsafe behaviour may result in removal from sessions.

Photography & Filming Consent: I give consent for Radojunkie Combat Academy to use photos and videos of me or my child for marketing, website, social media, funding applications and impact reporting.

Consent can be withdrawn at any time by emailing contact@radojunkie.com

Data Protection / GDPR Acknowledgement: I understand that the information provided will be stored securely and used only for safeguarding, communication and operational purposes, in line with GDPR.

SECTION 6: Declaration & Signature

19. Full Name of Signatory

20. Signature

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