Please PRINT and MAIL IN this form with your cheque
or EMAIL to email@example.com Online payments can also be made to this email via Paypal or other electronic transfer.
2016 November 11-13
PROVINCE/STATE, COUNTRY: __________________________
|Pre Registration Fees
|At the door Fees
||$200 at the door
||$90 at the door
FEES SENT WITH FORM CDN$______
Fees don't include travel/room/food.
PLEASE READ THE FOLLOWING CAREFULLY
I, the undersigned applicant to the CKF Fall Jodo Seminar and Grading understand
I am applying for instruction in jojutsu, an activity that involves
activity. I further understand that the Sei Do Kai and associated persons carries no
against injury to any of the participants in the seminar.
I hereby acknowledge that I am assuming the risk and responsibility
for any and all injuries that I may suffer,
caused by me or caused by third parties to me arising out of the
practice of Jodo, or during the use of any of the facilities available.
that I am responsible for providing my own personal health, medical,
and accident insurance coverage. I hereby release the Sei Do Kai and
all of its associated persons from liability for any
or loss suffered by myself.
DATE_______ SIGNATURE ______________________________
PARENT/GUARDIAN (under 18)___________________________
Please mail this form, cheques payable to:
Sei Do Kai
E/Mail to: Kim Taylor firstname.lastname@example.org at 44 Inkerman Street, Guelph Ontario Canada N1H 3C5