PRCP Participant Information & Safety Declaration

This form is provided to participants whose PRCP registration has been reviewed and approved by Huronia Goju-Ryu.

The information collected helps us prepare for your training, respond appropriately in an emergency, identify reasonable accommodation needs, and support safe participation throughout the course.

Please provide only information that is relevant to your participation in PRCP training. You are not being asked to provide a complete medical history.

Approved Participants Only

This form should only be completed after you have received an approval email and a PRCP participant file number from Huronia Goju-Ryu.

Completing this form does not replace any required waiver, online learning, payment, attendance, assessment, or certification requirement.

Before You Begin

Please have the following information available:

Your PRCP participant file number
Current contact information
Emergency-contact information
Information about any condition, limitation, allergy, medication effect, or accommodation relevant to safe participation
The Participant Information Package provided with your approval email

Most participants should be able to complete this form in approximately five to ten minutes.

Privacy and Information Use

Information submitted through this form will be used only for PRCP administration, participant safety, emergency response, course preparation, and accommodation planning.

Please do not provide detailed medical records, diagnostic reports, health-card numbers, complete medication lists, or other information that is not necessary for safe participation.

Information may be reviewed by authorized Huronia Goju-Ryu personnel involved in administering or delivering the applicable training.

Participant Responsibility

Participants are responsible for providing complete and accurate information relevant to their safe participation.

Huronia Goju-Ryu must be informed if relevant medical, physical, accessibility, or emergency-contact information changes before training begins.

Participants should not attend or continue training if they believe they are unable to participate safely. Instructors may modify, pause, or discontinue an activity when reasonably necessary for participant safety.

Fields marked with an asterisk (*) are required.

Participant Confirmation

Full Name *

PRCP Participant File Number *

Email Address *

Phone Number *

Please describe any registration information that has changed since you submitted your PRCP registration. If nothing has changed, write “No Changes.” *

Emergency Contact

Emergency Contact Name *

Relationship to You *

Emergency Contact Phone Number *

Health & Physical Readiness

Please disclose only information relevant to your safe participation or an appropriate emergency response. You are not being asked to provide a complete medical history.

Have you ever been advised by a physician or other healthcare professional not to participate in physical activity? If yes, explain. If not, write “No.” *

Please describe any current injury, illness, or medical condition that could affect your safe participation. If none, write “None.” *

Please describe any mobility limitations or physical restrictions instructors should be aware of. If none, write “None.” *

Please describe any allergies or medical conditions instructors should know about in the event of an emergency. Include any relevant emergency-response information. If none, write “None.” *

Are you currently pregnant? *

Please describe any medication that may affect your participation, balance, awareness, or physical performance. If none, write “None.” *

Accessibility & Accommodation

Please describe any accommodation required to participate fully in this course and how we can best support you. If no accommodation is required, write “None.” *

Course Administration

I confirm that I have received and reviewed the PRCP Participant Information Package.

Participant Declaration

Each declaration must be accepted before this form can be submitted.

I confirm that the information provided is complete and accurate to the best of my knowledge.

I understand that I am responsible for informing Huronia Goju-Ryu if my medical condition, physical condition, accessibility needs, emergency-contact information, or other information relevant to my safe participation changes before training.

I understand that I should not attend or participate in training if I believe I am unable to do so safely.

I agree to follow all instructor directions and safety requirements during PRCP training.

Thank you for completing your PRCP Participant Information & Safety Declaration. Your submission will be reviewed as part of your course preparation. Huronia Goju-Ryu may contact you if additional information, clarification, or accommodation planning is required before training.

Questions or Assistance

Please reply to your PRCP approval email if you have questions about this form, require assistance completing it, or are unsure whether particular information is relevant.

Do not submit highly sensitive medical documentation through this form unless Huronia Goju-Ryu has specifically requested it and provided appropriate instructions.

Disclaimer

PRCP is delivered through Huronia Goju-Ryu. Participant information is collected for legitimate training administration and safety purposes and should not be used for unrelated purposes.

Huronia Goju-Ryu

Ongeikan Karate-Jutsu