Introductly div ing , s no rk e li ng pa rt i ci pa t io n a ppli cat ion f or mNameFAMILYųNAMEᲩų ų ųųųųų ųųų ųųųųųFIRSTųNAME ᲩAddressCountry

Date of birthBlood typeSight
Body size

SexMan/ WomanųAųȷųBųȷųOųȷųABųųų᳌h+ųų᳌h- ųRightųųųųųųųųųųųLeft ųųųųųųųųųųųᲢNaked eye, Glasses, ContactsᲣ
Shoe sizeųųųųųųųųųųųHeightEmergency contact

Name

RelationshipųųųųTEL :*GCNVJEJGEM■Depending on your health condition, you may not be able to participate in the program.
■Please mark the following □ if you have the following illness or conditionࠋ
□ Puncture of tympanic membrane □ Meniere's disease □ Otitis media □ Chronic sinusitis (spores) □ Arrhythmia □ Tuberculosis□ Arthritis □ Nasal obstruction (nasal polyps, nasal septal curvature) □ spontaneous pneumothorax □ pulmonary emphysema□ Intrinsic bronchial asthma □ There are cavities filled with fillings in the teeth and unmatched prosthetic teeth□ Inflammation of the bronchus by smoking □ Glaucoma □ Tuberculosis left in the lungs Tuberculosis □ Valvular disease□ Coronary artery disease □ Conjunctivitis □ Paraplegia □ Epilepsy □ Acute respiratory infection (cold, pneumonia, bronchitis)□ Neurological disease □ myositis □ pancreatitis □ diabetes □ extreme obesity□ Cardiomyopathy □ Hypertension □ Psychiasis □ Alcoholism □ Neuralgia □ Migraine□ Spasm seizure / brain wave abnormality after head trauma□ Rheumatoid arthritis □ stroke (intracerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage) □ pregnancy□ stomach, duodenal ulcer □ hepatitis □ Severe motion sickness □ Poverty such as closed place, high place, open place□ Thyroid disease (oralgesia can not be adjusted) □ Allergic reactions caused by pollen, food, etc. that limit daily life and exercise□ When riding on an airplane or crossing a car by car, you can not balance the pressure in your ears and sinuses and feel pain
□ Ascend and descend on the chair 5 times in 5 seconds, measure the pulse and do not return within 45 seconds□ There are any respiratory or circulatory system abnormalities (exercise restriction by examination) after COVID-19 illness□ Diseases other than the above

0QVGU+HVJGEWUVQOGT UKPVGPVKQPQTPGINKIGPEGECWUGUVJGEWUVQOGTPQVVQHQNNQYVJGKPUVTWEVKQPUDCUGFQPVJGKPUVTWEVQT UUCHGV[QTVCMGCTDKVTCT[CEVKQPUVJGEWUVQOGTYKNNDGKPFCPIGTCPFNGCFVQCPCEEKFGPV9JKNGRCTVKEKRCVKPIKPVJGRTQITCOHQNNQYVJGKPUVTWEVQT UUCHGV[KPUVTWEVKQPU#NUQKH[QWHGGNCP[CDPQTOCNKV[FWTKPIVJGRTQITCORNGCUGKPHQTOVJGKPUVTWEVQTQH[QWTKPVGPVKQPVQECPEGNQTKPVGTTWRVRCTVKEKRCVKQP%QPHKTOCVKQPCVRTQITCOUVCTVŠKHVJGTGCTGU[ORVQOUUWEJCUNCEMQHUNGGRCNEQJQNKUOFTWIWUGQTRQQTJGCNVJ[QWECPPQVRCTVKEKRCVGKPVJG
RTQITCO
Š2NGCUGCPUYGTVJGHQNNQYKPISWGUVKQPUYKVJ;'5QT01
5NGGRKPIVKOGKUGPQWIJȷȷȷųųųųųųųų+JCXGPQVVCMGPCP[OGFKECVKQPȷȷȷųųųųųų+ OPQVIGVVKPIFTWPMȷȷȷųųų/[JGCNVJKUIQQFȷȷȷųųųųųųų+YQWNFNKMGVQRCTVKEKRCVGKPVQFC[ URTQITCOȷȷȷ
6JGTGCTGPQCNNGTIKETGCEVKQPUECWUGFD[RQNNKPQUKUQTHQQFȷȷȷ
6JGTGCTGPQTGURKTCVQT[QTEKTEWNCVQT[U[UVGOCDPQTOCNKVKGU GZGTEKUGTGUVTKEVKQPD[GZCOKPCVKQP CHVGT%18+&KNNPGUUȷȷȷų2TKXCE[RQNKE[1WTUJQRTGEQIPK\GUVJGKORQTVCPEGQH[QWTRGTUQPCNKPHQTOCVKQPUVTKXGUVQGPUWTGKVURTQVGEVKQPQDUGTXGUVJGNCYUTGICTFKPIRGTUQPCNKPHQTOCVKQP
CPFCFJGTGUVQVJGHQNNQYKPIRTKXCE[RQNKE[VQRTQVGEVKPHQTOCVKQPCDQWV[QWᲫ9GYKNNPQVWUG[QWTRGTUQPCNKPHQTOCVKQPHQTCP[RWTRQUGQVJGTVJCPRTQXKFKPIVTCKPKPICPFFKXKPIKPHQTOCVKQPCPFKUUWKPICEGTVKHKECVG
9GYKNNKORNGOGPVCRRTQRTKCVGCPFTGCUQPCDNGUGEWTKV[OGCUWTGUCICKPUVVJGTKUMQHWPCWVJQTK\GFCEEGUUVQEWUVQOGT URGTUQPCNKPHQTOCVKQPCPFNQUUHCNUKHKECVKQPQTNGCMCIGQHRGTUQPCNKPHQTOCVKQP6JGTGKUPQQWVUQWTEKPIQHVJGJCPFNKPIQHRGTUQPCNKPHQTOCVKQP6JGEQNNGEVGFRGTUQPCNKPHQTOCVKQPOC[DGWUGFHQTRTQFWEVFGXGNQROGPVCPFOCTMGVKPICEVKXKVKGUDWVKH[QWEQPVCEVWUYGYKNNPQVEQPVCEV[QWUGPFDTQEJWTGUGVE+H[QWCTGRTQXKFGFYKVJRGTUQPCNKPHQTOCVKQPYGOC[GOCKNQTQVJGTYKUGUGPF[QWKPHQTOCVKQPVJCV[QWOC[DGKPVGTGUVGFKP+H[QWFQPQVYKUJVQFKUVTKDWVGVJKUKPHQTOCVKQPYGYKNNKOOGFKCVGN[UVQRFKUVTKDWVKPIVJGKPHQTOCVKQPWRQPEQPVCEV9GYKNNPQVFKUENQUGQTRTQXKFG[QWTRGTUQPCNKPHQTOCVKQPVQVJKTFRCTVKGUYKVJQWV[QWTQYPEQPUGPV*QYGXGTKHTGSWKTGFD[NCYYGOC[FKUENQUG
CPFRTQXKFGRGTUQPCNKPHQTOCVKQPYKVJQWV[QWTEQPUGPV

I agree to the above and I will sign the following as proof that my declaration is true.
DateųųųųųųųųųųųųSignatureųųųųųųųųųųųParent's signature (for minors)