Please PRINT and MAIL IN this form or EMAIL to email@example.com Online payments can also be made to this email
2016 September, 3-5
PROVINCE/STATE, COUNTRY: __________________________
|Daily Rate ___ SESSIONS X $60CDN = $______
|3 Days $150.00CDN___
FEES SENT WITH FORM CDN$______
Fees don't include travel/room/food.
PLEASE READ THE FOLLOWING CAREFULLY
I, the undersigned applicant to the Tombo Dojo Fall Kage Ryu Seminar understand
I am applying for instruction in kenjutsu, an activity that involve
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 due to injury, suffered by
or caused by third parties to me arising out of the practice of Niten
Kage Ryu, or during the use of any of the facilities available. I further
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