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ATTENTION

PLEASE COMPLETE THIS PRIOR TO COMING BACK TO FACE-TO-FACE CLASS

Applicable for Kinder 5 and above classes only as the children will be attending classes independently.
If you have any questions, please reach out to Shichida centre on 1800 386 647 .

Indemnity Form

I understand that I am required to stay on the premises of Shichida Australia Pty Ltd while my child is in class.
I understand that Shichida Australia Pty Ltd’s public liability does not cover situations when I am out of the premises of Shichida Australia Pty Ltd if my child attends class independently.
I waive and release all claims I may have against Shichida Australia Pty Ltd (A.C.N. 136 613 084), its officers, directors, members, employees, agents, other participants and any other persons involved in the provision of the services offered at the Centre (“the releasees”), including any and all claims for damages caused by negligence or otherwise, arising out of my absence, together with any costs including legal fees that may be incurred as a result of any such claim whether valid or not.
I acknowledge and agree to abide, and to ensure my child abides, by all the rules, regulations and instructions provided by Shichida Australia Pty Ltd or Shichida staff from time to time during the provision of the services offered at the Centre.

Guardian's First Name

Guardian's Last Name

Contact Number

I hereby agree to the above for myself and/or my child, my executors, administrators, heirs, next of kin, successors and assigns

Submit