1 WEEK FREE CLASSES
AND FREE UNIFORM ON JOINING

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STUDENT DETAILS

Name(Required)

First Last

Address

Street Address Suburb Postal Code

Mobile(Required)

Email(Required)

Gender

Male

Female

Medical Information / Injuries & Medical Condition(Required)

Any Special Learning Requirements or Difficulties

Membership Type(Required)

Silver 1-2 classes per week $ 65.90 fortnightly

Gold 3+1 Free = 4 classes per week, $ 85.50 fortnightly

Platinum Unlimited classes per week $ 105.50 fortnightly

TUITION FEES: THE UNDERSIGNED AGREES TO PAY training fee of $65.90 plus $1.95 admin fee per fortnight. I acknowledge that I am entering into a 12 months membership agreement. Training fee are divided in equal payments for the purpose of budgeting.

TUITION FEES: THE UNDERSIGNED AGREES TO PAY training fee of $85.90 plus $1.95 admin fee per fortnight. I acknowledge that I am entering into a 12 months membership agreement. Training fee are divided in equal payments for the purpose of budgeting.

TUITION FEES: THE UNDERSIGNED AGREES TO PAY training fee of $105.50 plus $1.95 admin fee per fortnight. I acknowledge that I am entering into a 12 months membership agreement. Training fee are divided in equal payments for the purpose of budgeting.

Parents Details

Mother's Name

First Last

Mother's Mobile

Father's Name

First Last

Father's Mobile

Emergency Contact

Name(Required)

First Last

Relationship

Phone(Required)

I, THE UNDERSIGNED, do hereby apply for membership to White Wolf Martial Arts, and certify that all information supplied by me is correct. I UNDERSTAND that my tuition is arranged to be made in fortnightly instalments or set term payments in advance and is not affected by my lesson schedule and/or attendance. Tuition fees will be debited from my account or credit card each fortnight. Training Fees are non-refundable.
I UNDERSTAND that unless I provide written notice of termination of my membership prior to the end of the minimum period of my periodic billing membership agreement, my membership fees will continue to be deducted until 30 days after I provide written notice after the agreed term. I am required to give one-month notice of cancellation by completing the appropriate cancellation form. Cancellation will not be accepted by phone or by mail unless on the prescribed form. Paid in full tuition payments can be held in credit but not refunded.

I UNDERSTAND that training fees are calculated and paid over 12 months period including all club closures/public holidays.

I UNDERTAND that cancellation policy is 20% discount of the remaining agreement amount owing to be paid out.

I UNDERTAND that any payments shall be made whether or not I use the facilities at White Wolf Martial Arts.

I UNDERSTAND that a failure to complete training does not relieve me of my obligation to pay the fortnight tuition in full. I UNDERSTAND and agree that the school will not be held liable for injuries, damages etc., not caused by or resulting from the negligence of the owners, operators, employees or persons in charge of the establishment.

I UNDERSTAND that under the terms of this agreement, the school obligates itself to furnish me with competent instruction and suitable facilities for teaching lessons. All class sessions are supervised by personnel trained in the procedures and traditions of the martial arts.

THE STUDENT hereby represents that he/she is physically fit to receive and participate in the prescribed course of instruction.

THE STUDENT understands that Martial Arts area contact sport and assumes the risk of and responsibility for any injury, death or property damage resulting from their participation in the activity.

I WILL conduct myself with appropriate behavior as befitting the values of White Wolf Martial Arts, and will faithfully comply with all the rules and regulations of the school and the traditions of the martial arts.

I UNDERSTAND White Wolf Martial Arts regularly takes photographs/videos and reproduces photographs and videos, of patrons on White Wolf Martial Arts property or at a White Wolf Martial Arts organised event for use in its publications, promotional and marketing material, on its website and in advertising both internally and externally, to promote White Wolf Martial Arts. I understand that by signing these terms and conditions I give White Wolf Martial Arts, who is either employed or commissioned by White Wolf Martial Arts, to make and use my/my child’s picture and authorise the use and reproduction of it by White Wolf Martial Arts, or any authorised by White Wolf Martial Arts management. This includes any and all photographs and videos which the aforementioned have this day taken of me, for any purpose whatsoever, without compensation to me. I understand and agree that all/or any negatives and positives, together with the prints shall be and remain the sole property of White Wolf Martial Arts.

I acknowledge that whilst at White Wolf Martial Arts, both my property and my person shall be at my own risk, and I will not hold White Wolf Martial Arts or its staff, directors or volunteers liable for any personal injury or loss of property arising whilst on these premises.

I have read and understood the above and agree to all terms and conditions of the agreement.

I ACKNOWLEDGE receiving a copy of this agreement.

Signature of Joining / Parent or Guardian if Under 18(Required)

Date

Paysmart Direct Debit Form

PO Box 5567, Stafford Heights, Qld 4053 Phone: (07) 3866 9100 Fax: (07) 3866 9199 www.ffapaysmart.com.au

FFA Paysmart Pty Ltd ACN 117 597 010 AR No. 409047 is an authorised representative of Transaction Services Holdings Limited AFSL 338256 authorised to provide general advice about and issue billing sevices.

White Wolf Martial Arts – NSW

New Direct Debit Request

Customer Details (PLEASE USE BLOCK LETTERS)

Parent's Name

Child's Name

Address

Street Name and Number Suburb Postal Code

DOB

Driver's License No.

Telephone

Customer Payment Details

Silver 1-2 classes per week $ 65.90 fortnightly

Gold 3+1 Free = 4 classes per week, $ 85.50 fortnightly

Platinum Unlimited classes per week $ 105.50 fortnightly

Regular Debit Amount fortnightly

Plus $1.95 admin fee each fortnight

Commencing on(Required)

Your first debit will start next business day from the date of this form. It will then be changed and adjusted to Friday fortnightly.

Until Further Notice (min 26 payments)

NOTE: A SET UP FEE of $11 will be added to the first payment only.

Special Conditions:

CUSTOMER DIRECT DEBIT FROM BANK ACCOUNT

Bank Name

Branch Account Opened

BSB Number

Account Number

Account Holder Name (as it appears on bank statement)

Given Name/s Surname

I/We authorize FFA PaySmarty Pty Ltd User ID 073053 to debit my/our account at the Bank identified above through the Bulk Electronic Clearing System (BECS) in accordance to the Payment Details above and as per the Service Agreement provided

Verified by _______________________________________________________

CUSTOMER DEBIT FROM CREDIT CARD

Please charge payments as detailed above to my (tick one)

Visa

Mastercard

Amex

Name on Card

Given Name/s Surname

Note: FFA PaySmart will appear on your credit card statement

Credit Card Number

Expiry Date

By signing below, I understand that a surcharge of 1.6% for Visa and Mastercard and 3.5% for Amex will be added to each payment (Delete if not applicable)

Due to an upgrade in banking regulations (PCI DSS) we cannot accept this form by EMAIL. Please POST or FAX original to FFA PaySmart. Alternatively details can be submitted via eDDR or upload express in Web Express.

DISTRIBUTION: *WHITE COPY send to FFA PaySmart *YELLOW: Business Copy *PINK: Customer Copy

CUSTOMER AUTHORISATION

This Authorisation is to remain in force in accordance with the Terms and Conditions on this page, the provided Service Agreement, and I/We have read and understand the same

Direct Debit Request Service Agreement

1. FFA Paysmart (Debit User) will debit the bank account / credit card nominated in the Schedule of this Direct Debit Request as specified. The Debit User may, by prior arrangement and advice to me/us vary the amount or frequency of future debits.

2. Should the original terms & conditions of this authority need to be varied a minimum of fourteen days notice will be provided by the business to you. Queries arising as a result of any such variations must be notified to FFA PaySmart two working days prior to the debit date the variation would apply.

3. Deferment or alteration (written or verbal) by the customer to the debiting schedule will be considered subject to terms and conditions of any agreement between you and the business named overleaf for whom FFA PaySmart (Debit User) acts on behalf of.

4. If a debit item is disputed FFA PaySmart (Debit User) or your Financial Institution must be notified immediately. FFA PaySmart will endeavour to resolve this matter within Industry agreed time frames. Disputed debit items resolved in favour of FFA PaySmart will incur an administration fee.

5. Direct debiting through BECS is not available on all accounts. You are advised your account details against recent statement form your financial institution. If uncertain, you should check with your financial institution before completing the DDR.

6. When a debit falls on weekend and/or national public holiday all debits for that weekend or national public holiday will be processed on the PREVIOUS WORKING DAY. If unsure, you should contact FFA PaySmart (Debit User).

7. FFA PaySmart may, under certain provisions of the “Privacy Act. 1988” give information about you to a credit reporting agency. This information will be limited to repayments which are overdue pursuant to the terms and conditions of any contractual agreement between you and the business named overleaf and for which debt collection has started. You “The Customer” may be liable for any costs associated with the recovery of your overdue account, this may include, but is not limited to the following: legal fees, interest and mercantile agency collection cost.

8. It is your responsibility to ensure cleared funds are available in your nominated bank account.credit card to meet the direct debit payment. If a debit is returned unpaid by your financial institution, wil be responsible for payment of the debit plus an additional $15.00 for return fees and administrative costs incurred by FFA PaySmart (Debit User). If FFA PaySmart (Debit User) has not received instruction to the contrary from you, we will debit both the next due payment and any overdue amounts on your next scheduled debit date.

9. This authority shall stand pursuant to the terms and conditions of any contractual agreement between you and business named overleaf. The administration only of this authority is conducted by FFA PaySmart (Debit USer) acting as a billing agent for the business. The services provided by FFA PaySmart are administrative only and do not extend to the provision of any services or benefits provided by the business/ centre. This authority shall be interpreted and enforced pursuant to the laws of the state of Queensland.

10. To stop or cancel a direct debit it is recommended that you contact the business named overleaf in the first instance. The terms and conditions or any agreement between you and the business for whom FFA PaySmart (Debit USer) acts on behalf of must be complied with. However , if a dispute occurs between you and the business all enquiries regarding a stop or cancellation of a direct debit should be directed to either FFA PaySmart (Debit User) or your own financial institution.

11. Collected funds are held in trust until disbursement. In event of fraud where FFA PaySmart is not at fault, FFA PaySmart will be free of any legal liability.

12. No account records or details will be disclosed to any person or persons except where such information is required in connection with any claim relating to an alleged incorrect or wrongful debit.

13. All inquiries in relation to refunds must be directed to the business named overleaf.

Signature/s of Nominated Account Holder/s

Date(Required)

WHITE WOLF MARTIAL ARTS

1 WEEK FREE CLASSES AND FREE UNIFORM ON JOINING

STUDENT DETAILS

Parents Details

Emergency Contact

Paysmart Direct Debit Form

White Wolf Martial Arts – NSW

Customer Details (PLEASE USE BLOCK LETTERS)

Customer Payment Details

CUSTOMER DIRECT DEBIT FROM BANK ACCOUNT

CUSTOMER DEBIT FROM CREDIT CARD

CUSTOMER AUTHORISATION

Direct Debit Request Service Agreement

1 WEEK FREE CLASSES
AND FREE UNIFORM ON JOINING