Applicants Name *

NOTE: The grading Certificate will be produce as per the information on this form. If the information is incorrect a replacement certificate will cost £5.

First Name

Last Name

Date of Birth *

day, month, year

MM

DD

YYYY

Applicant Phone Number

Applicants under 18 yrs old: By putting your child’s contact number, you consent for NWAC to contact them via their contact number..

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Emergency Contact 1 Name *

First Name

Last Name

Emergency Contact 1 Phone Number *

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Emergency Contact 2 Name *

First Name

Last Name

Emergency Contact 2 Phone Number *

Please provide a phone number of an ADDITIONAL emergency contact

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Acknowledgements: I understand that this event is run under New Wave rules. I accept that I cannot hold any representative of NWAC responsible for any loss of personal items or for any injuries that may be sustained during the grading. I also accept, in full, the decision of the grading officials on the day. I have read the ‘publicity release’ and agree to the terms of the release. I also understand, that by including either the email contact or mobile number of applicants under the age of 18, I consent for NWAC to contact them using either of these methods. If student is under 18, this form must be signed by a parent or guardian. *

*It is necessary to click agree otherwise we cannot accept your application.

Agree

Name of the person signing agreement. *

First Name

Last Name

Date *

MM

DD

YYYY