Declaration
1. Do you have any previous criminal convictions that resulted in imprisonment or are you currently under investigation or serving any sentence or awaiting court proceedings? yes no
If you have any previous criminal convictions that resulted in imprisonment or any other custodial sentence including home detention, you must provide a copy of your criminal history to proceed with this application.
2. Purpose for training?
3. Have you ever had psychiatric treatment? yes no
If yes, please provide details:
4. Have you ever been involved or have or had a personal association with any gang or gang members or organised crime or criminals? yes no
If yes, please provide details:
5. Have you ever been involved with any terrorist, political, religious, or ethnic organizations that promote the use of violence or breach the civil rights, religion, or race of any person, or whose purpose is to act against the Government of New Zealand or any other country by illegal means? yes no
If yes, please provide details:
6. Do you have any health problems that may endanger you by training in CQC? yes no
If yes, please provide details:
7. Do you agree to accept the instructor’s instructions and teachings, to train responsibly with safety in mind and never put your instructor or fellow exponents at risk or in danger of injury? yes no
8. Do you have or have you ever had an addiction to drugs or alcohol? yes no
If yes, please provide details:
9. Have you ever had any previous experience in military close combat, martial arts, boxing, wrestling, or self-defence? yes no
If yes, please provide details:
10. Have you ever had any previous training or service in the military, police, corrections, close protection, or special investigations? yes no
If yes, please provide details:
11. Have you ever been refused Todd Group HQ or a Todd Group Depot membership or course joining acceptance? yes no
If yes, please provide details:
12. Have you ever had Todd Group membership revoked, been removed from a course, resigned your membership or withdrawn yourself from a course under a complaint investigation or disciplinary action. yes no
If yes, please provide details:
13. Do you agree not to reveal or instruct anyone in any of the Todd Group tradecraft training you will undertake/receive as a training member or former member? yes no
14. Do you agree to abide by all agreement contract rules and regulations? yes no
Confirmation of the above being true and correct
If your answers or information are found to be untrue, misleading, or in breach of any of your membership agreements/contracts, your membership/course joining, or course participation will be immediately revoked, and any required action undertaken.
I have read the full course information and confirm that all answers and information that I have provided on this official form are true and correct.
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